Mount St. Helens aerosol evolution

Energy Technology Data Exchange (ETDEWEB)

Oberbeck, V.R.; Farlow, N.H.; Fong, W.; Snetsinger, K.G.; Ferry, G.V.; Hayes, D.M.

1982-09-01

Stratospheric aerosol samples were collected using a wire impactor during the year following the eruption of Mt. St. Helens. Analysis of samples show that aerosol volume increased for 6 months due to gas-to-particle conversion and then decreased to background levels in the following 6 months.

Oncologists' non-verbal behavior and analog patients' recall of information.

Science.gov (United States)

Hillen, Marij A; de Haes, Hanneke C J M; van Tienhoven, Geertjan; van Laarhoven, Hanneke W M; van Weert, Julia C M; Vermeulen, Daniëlle M; Smets, Ellen M A

2016-06-01

Background Information in oncological consultations is often excessive. Those patients who better recall information are more satisfied, less anxious and more adherent. Optimal recall may be enhanced by the oncologist's non-verbal communication. We tested the influence of three non-verbal behaviors, i.e. eye contact, body posture and smiling, on patients' recall of information and perceived friendliness of the oncologist. Moreover, the influence of patient characteristics on recall was examined, both directly or as a moderator of non-verbal communication. Material and methods Non-verbal communication of an oncologist was experimentally varied using video vignettes. In total 194 breast cancer patients/survivors and healthy women participated as 'analog patients', viewing a randomly selected video version while imagining themselves in the role of the patient. Directly after viewing, they evaluated the oncologist. From 24 to 48 hours later, participants' passive recall, i.e. recognition, and free recall of information provided by the oncologist were assessed. Results Participants' recognition was higher if the oncologist maintained more consistent eye contact (β = 0.17). More eye contact and smiling led to a perception of the oncologist as more friendly. Body posture and smiling did not significantly influence recall. Older age predicted significantly worse recognition (β = -0.28) and free recall (β = -0.34) of information. Conclusion Oncologists may be able to facilitate their patients' recall functioning through consistent eye contact. This seems particularly relevant for older patients, whose recall is significantly worse. These findings can be used in training, focused on how to maintain eye contact while managing computer tasks.

78 FR 43064 - Safety Zone; Maritime Heritage Festival Fireworks, St. Helens, OR

Science.gov (United States)

2013-07-19

...-AA00 Safety Zone; Maritime Heritage Festival Fireworks, St. Helens, OR AGENCY: Coast Guard, DHS. ACTION... associated with fireworks displays. As part of the Maritime Heritage Festival Fireworks in St. Helens, OR, the festival will feature a fireworks display. The Coast Guard expects approximately 1,000 people to...

The relationship between oncologists and peripheral hospital radiologists in the north-west of England

International Nuclear Information System (INIS)

Bungay, Peter M.; Carrington, Bernadette M.; Corgie, Delphine; Eardley, Anne

2002-01-01

AIM: To audit the relationship between Cancer Centre oncologists visiting peripheral hospitals and peripheral hospital radiologists by assessing (i) oncologists' knowledge of local radiological services; (ii) oncologists' perceptions of peripheral radiological services; (iii) peripheral radiologist's perceptions of oncologists; (iv) barriers to communication. MATERIALS AND METHODS: A postal questionnaire was sent to all radiology departments visited by an oncologist, and to all medical and clinical oncologists from two regional oncology centres. RESULTS: The response rate was 100% (21 peripheral hospital radiology departments and all 35 oncologists). (i) Oncologists' knowledge of peripheral hospital imaging modalities was limited (especially MRI and intervention). (ii) 72% of oncologists rated the peripheral hospital radiology service as excellent or good, 46% rated the radiology report quality excellent to good. Deficiencies in oncological reports were identified. (iii) 44% of radiologists thought the oncologist did not relate well with the local radiology department. 50% of radiologists did not know the visiting oncologist's specialist interest. (iv) 69% of oncologists did not regularly attend peripheral hospital clinico-radiological meetings. Lack of written and oral information was hampering both specialities. CONCLUSION: Communication between oncologists and the local radiology department should include: (1) information about local radiology services for visiting oncologists (including trainees) and on the oncology team for radiologists; (2) standardized report content; (3) improved clinical information for radiologists; (4) regular clinico-radiological meetings. Bungay, P.M. et al. (2002)

Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer.

Science.gov (United States)

Mohile, Supriya G; Magnuson, Allison; Pandya, Chintan; Velarde, Carla; Duberstein, Paul; Hurria, Arti; Loh, Kah Poh; Wells, Megan; Plumb, Sandy; Gilmore, Nikesha; Flannery, Marie; Wittink, Marsha; Epstein, Ronald; Heckler, Charles E; Janelsins, Michelle; Mustian, Karen; Hopkins, Judith O; Liu, Jane; Peri, Srihari; Dale, William

2018-03-01

Background: This study's objectives were to describe community oncologists' beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that "the care of older adults with cancer needs to be improved" (89%) and that "geriatrics training is essential" (72%). However, decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73-9.20), normal cognition (aOR, 5.42; 95% CI, 3.01-9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12-7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43-7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36-7.20, impaired function: aOR, 2.48; 95% CI, 1.12-5.72). Oncologists' characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists' treatment decisions. Copyright © 2018 by the National Comprehensive Cancer Network.

Responding to family requests for nondisclosure: the impact of oncologists' cultural background.

Science.gov (United States)

Chittem, Mahati; Butow, Phyllis

2015-01-01

Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. To explore differences in the attitudes and practices of Western-born and nonWestern born oncologists in Australia when faced with a nondisclosure request. Using a cross-sectional design, oncologists were interviewed over the telephone. Using the snowball method, 14 Australian (Western = 9, non-Western = 5) oncologists were recruited. Oncologists participated in a semi-structured interview exploring their experiences of, and response to, a request for nondisclosure, and their perceptions of how their cultural background influenced these attitudes and responses. The interviews were transcribed and analyzed using interpretative phenomenological analysis. Six main themes emerged from the study: (1) Barriers to truthful communication, (2) an ethical and moral dilemma, (3) high costs of nondisclosure, (4) cultural influences on interpretation and understanding of requests for nondisclosure, (5) emotional impact of bad news on patients, families and oncologists, and (6) truthful disclosure as a gentle balancing act. All oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. Some immigrant Australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. Irrespective of their cultural background, all oncologists acknowledged that breaking bad news had to be done in a gentle, gradual manner. The study suggests a need to develop a culturally sensitive cancer communication model.

May 1980 Mount Saint Helens, USA Images

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — An earthquake occurred at 15 32 UT, only seconds before the explosion that began the eruption of Mount St. Helens volcano. This eruption and blast blew off the top...

The Helen logos and Herodotus’ Fingerprint

NARCIS (Netherlands)

de Jong, I.; Baragwanath, E.; de Bakker, M.

2012-01-01

Herodotus' discussion of the Trojan War in Histories 2.112-20 consists mainly of two strands: a historiographical evaluation of his sources, Homer and the Egyptian priests (116-17, 120), and the presentation of an alternative version (Helen never went to Troy but stayed in Egypt), as heard from the

Oncologists' negative attitudes towards expressing emotion over patient death and burnout.

Science.gov (United States)

Granek, Leeat; Ben-David, Merav; Nakash, Ora; Cohen, Michal; Barbera, Lisa; Ariad, Samuel; Krzyzanowska, Monika K

2017-05-01

The aims of this study were to examine the relationship between negative attitudes towards expressing emotion following patient death and burnout in oncologists and to explore oncologists' preferences for institutional interventions to deal with patient death. The participants included a convenience sample of 177 oncologists from Israel and Canada. Oncologists completed a questionnaire package that included a sociodemographic survey, a burnout measure, a survey assessing negative attitudes towards expressing emotion, and a survey assessing desired interventions to cope with patient death. To examine the association between burnout and negative attitudes while controlling for the effect of sociodemographic variables, a hierarchical linear regression was computed. Higher burnout scores were related to higher negative attitudes towards perceived expressed emotion (partial r = .25, p training) helpful in coping with patient death. Our findings suggest that high burnout scores are associated with negative attitudes towards expressing emotion and that there is a wide variation in oncologist preferences in coping with patient death. Institutions should promote interventions that are varied and that focus on the needs of oncologists in order to reduce burnout. Interventions that legitimize expression of emotion about patient death may be useful. Another way to reduce stigma would be to require oncologists to "opt out" rather than "opt in" to accessing a selection of social and/or individual interventions.

Friendly Letters on the Correspondence of Helen Keller, Anne Sullivan, and Alexander Graham Bell.

Science.gov (United States)

Blatt, Burton

1985-01-01

Excerpts from the letters between Alexander Graham Bell and Anne Sullivan and Helen Keller are given to illustrate the educational and personal growth of Helen Keller as well as the educational philosophy of Bell regarding the education of the deaf blind. (DB)

Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

International Nuclear Information System (INIS)

Jagsi, Reshma; Abrahamse, Paul; Morrow, Monica; Hamilton, Ann S.; Graff, John J.; Katz, Steven J.

2012-01-01

Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study

Energy Technology Data Exchange (ETDEWEB)

Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Abrahamse, Paul [Department of Internal Medicine, University of Michigan, Ann Arbor, MI (United States); Morrow, Monica [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hamilton, Ann S. [Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA (United States); Graff, John J. [Department of Radiation Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Katz, Steven J. [Department of Internal Medicine, Division of General Medicine and Department of Health Management and Policy, School of Public Health, University of Michigan Health System, Ann Arbor, MI (United States)

2012-04-01

Purpose: To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists. Methods and Materials: We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios. Results: 92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001). Conclusions: Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.

Making sense of Mount St. Helens

Science.gov (United States)

Steve Nash

2010-01-01

The eruption of Mount St. Helens in 1980 resulted in "a grand experiment that you could never have gotten anybody to fund," says Forest Service ecologist Charles Crisafulli. "Everything's new. It's a new landform." Unlike most misbehaving volcanoes, this one provided an accessible laboratory right along the Interstate-5 corridor, with the...

ONCOLOGISTS' BARRIERS AND FACILITATORS FOR ONCOTYPE DX USE: QUALITATIVE STUDY.

Science.gov (United States)

Roberts, Megan C; Bryson, Amy; Weinberger, Morris; Dusetzina, Stacie B; Dinan, Michaela A; Reeder-Hayes, Katherine; Wheeler, Stephanie B

2016-01-01

Oncotype DX (ODX), a tumor gene profiling test, has been incorporated into clinical guidelines to aid in adjuvant chemotherapy decision making for early-stage, hormone receptor positive breast cancer patients. Despite United States (U.S.) guidelines, less than half of eligible women receive testing. Reasons for low usage are unclear: Our objective was to better understand U.S. oncologists' ODX uptake and how they use ODX during adjuvant chemotherapy decision making. We conducted semi-structured, ~30-minute phone interviews with medical and surgical oncologists in one U.S. State using purposive sampling. Oncologists were included if they saw greater than or equal to five breast cancer patients per week. Recruitment ended upon thematic saturation. Interviews were recorded, transcribed, and double-coded using template analysis. During analysis, themes emerged across three domains. First, organizational factors (i.e., departmental structure, ODX marketing, and medical/insurance guidelines) influenced ease of ODX use. Second, oncologists referenced the influence of interpersonal factors (e.g., normative beliefs and peer use of ODX) over their own practices and recommendations. Third, intrapersonal factors (e.g., oncologist attitudes, perceived barriers, and research gaps) were discussed: although oncologists largely held positive attitudes about ODX, they reported challenges with interpreting intermediate scores for treatment decisions and explaining test results to patients. Finally, oncologists identified several research gaps. As more tumor gene profiling tests are incorporated into cancer care for treatment decision making, it is important to understand their use in clinical practice. This study identified multi-level factors that influence ODX uptake into clinical practice, providing insights into facilitators and modifiable barriers that can be leveraged for improving ODX uptake to aid treatment decision making.

Racism, Disable-ism, and Heterosexism in the Making of Helen Keller

OpenAIRE

Prettol, Andy

2008-01-01

In his paper "Racism, Disable-ism, and Heterosexism in the Making of Helen Keller" Andy Prettol offers an analysis of prevailing narratives about Helen Keller. Prettol focuses on the dynamic interplay of race, (dis)ability, sexuality, and gender inherent to all Keller stories of triumph that are so popular in elementary schools across the U.S. He examines three specific works: William Gibson's playscript The Miracle Worker, written in 1956; the film of the same title directed by Arthur Penn i...

Special report: Mt. St. Helens

Science.gov (United States)

Mt. St Helens Volcano, Cascade Range, Southern Washington, USA (46.20°N, 122.18°W.) All times are local (GMT - 7 h through October 24, GMT - 8 h thereafter. Lava extrusion that probably began October 30 added a new lobe to the composite dome in the crater of Mt. St. Helens. After lava extrusion ended September 10 (see September 22 Eos), rates of deformation in the crater remained low for several weeks, as they had after earlier extrusion episodes. Sulfur dioxide emission ranged from 70 to 190 tons per day between October 9 and 24, but showed no particular trends. Inflation of the dome has caused small thrust faults to form in the surrounding crater floor. In early October the most active thrust, south of the dome, was moving at about 1.5 cm/d, and stations on the north crater rampart showed outward movement of about 0.5 cm/d. By October 24 these rates had increased to 14.5 and 3.5-4 cm/d, respectively, and leveling profiles perpendicular to the dome showed that crater floor tilt rates had reached 400-500 μrad/d, prompting the U.S. Geological Survey (USGS) to issue an advisory prediction of renewed lava extrusion within the next two weeks.

The opsis of Helen: Performative Intertextuality in Euripides

Directory of Open Access Journals (Sweden)

Aspasia Skouroumouni Stavrinou

2015-02-01

Full Text Available Features of the play’s staging, costume, and gestures achieve a series of allusions to comparable features in the genre of comedy and thus reinforce the comic elements of the plot and characters of Helen.

Mount St. Helens, 1980 to now—what’s going on?

Science.gov (United States)

Dzurisin, Daniel; Driedger, Carolyn L.; Faust, Lisa M.

2013-01-01

Mount St. Helens seized the world’s attention in 1980 when the largest historical landslide on Earth and a powerful explosive eruption reshaped the volcano, created its distinctive crater, and dramatically modified the surrounding landscape. An enormous lava dome grew episodically in the crater until 1986, when the volcano became relatively quiet. A new glacier grew in the crater, wrapping around and partly burying the lava dome. From 1987 to 2003, sporadic earthquake swarms and small steam explosions indicated that magma (molten rock) was being replenished deep underground. In 2004, steam-and-ash explosions heralded the start of another eruption. A quieter phase of continuous lava extrusion followed and lasted until 2008, building a new dome and doubling the volume of lava on the crater floor. Scientists with the U.S. Geological Survey and University of Washington’s Pacific Northwest Seismograph Network maintain constant watch for signs of renewed activity at Mount St. Helens and other Cascade volcanoes. Now is an ideal time for both actual and virtual visitors to Mount St. Helens to learn more about dramatic changes taking place on and beneath this active volcano.

Helen Lehismets võitis vaibakavandite konkursi / Lea Pruuli

Index Scriptorium Estoniae

Pruuli, Lea

1999-01-01

Tarbekunstimuuseumi vaibakavandite konkursil "Kootud pildid" valiti teostamiseks tekstiilikunstnik Helen Lehismetsa vaibakavand "Aed". Ostupreemia ئ Urmas Viigi kavandile "EW ja AW". Osalejad. Konkursile esitatud kavandeid ja vaibaks kootud peapreemiatööd eksponeeritakse Tarbekunstimuuseumis 22. okt. avataval näirtusel "Kootud pildid".

The Effects of Interruptions on Oncologists' Patient Assessment and Medication Ordering Practices

Directory of Open Access Journals (Sweden)

Patricia L. Trbovich

2013-01-01

Full Text Available Interruptions are causal factors in medication errors. Although researchers have assessed the nature and frequency of interruptions during medication administration, there has been little focus on understanding their effects during medication ordering. The goal of this research was to examine the nature, frequency, and impact of interruptions on oncologists' ordering practices. Direct observations were conducted at a Canadian cancer treatment facility to (1 document the nature, frequency, and timing of interruptions during medication ordering, and (2 quantify the use of coping mechanisms by oncologists. On average, oncologists were interrupted 17 % of their time, and were frequently interrupted during safety-critical stages of medication ordering. When confronted with interruptions, oncologists engaged/multitasked more often than resorting to deferring/blocking. While some interruptions are necessary forms of communication, efforts must be made to reduce unnecessary interruptions during safety-critical tasks, and to develop interventions that increase oncologists' resiliency to inevitable interruptions.

Negative emotions in cancer care: do oncologists' responses depend on severity and type of emotion?

Science.gov (United States)

Kennifer, Sarah L; Alexander, Stewart C; Pollak, Kathryn I; Jeffreys, Amy S; Olsen, Maren K; Rodriguez, Keri L; Arnold, Robert M; Tulsky, James A

2009-07-01

To examine how type and severity of patients' negative emotions influence oncologists' responses and subsequent conversations. We analyzed 264 audio-recorded conversations between advanced cancer patients and their oncologists. Conversations were coded for patients' expressions of negative emotion, which were categorized by type of emotion and severity. Oncologists' responses were coded as using either empathic language or blocking and distancing approaches. Patients presented fear more often than anger or sadness; severity of disclosures was most often moderate. Oncologists responded to 35% of these negative emotional disclosures with empathic language. They were most empathic when patients presented intense emotions. Responding empathically to patients' emotional disclosures lengthened discussions by an average of only 21s. Greater response rates to severe emotions suggest oncologists may recognize negative emotions better when patients express them more intensely. Oncologists were least responsive to patient fear and responded with greatest empathy to sadness. Oncologists may benefit from additional training to recognize negative emotions, even when displayed without intensity. Teaching cancer patients to better articulate their emotional concerns may also enhance patient-oncologist communication.

Satisfaction with work-life balance and the career and retirement plans of US oncologists.

Science.gov (United States)

Shanafelt, Tait D; Raymond, Marilyn; Kosty, Michael; Satele, Daniel; Horn, Leora; Pippen, John; Chu, Quyen; Chew, Helen; Clark, William Benton; Hanley, Amy E; Sloan, Jeff; Gradishar, William J

2014-04-10

To evaluate satisfaction with work-life balance (WLB) and career plans of US oncologists. The American Society of Clinical Oncology conducted a survey of US oncologists evaluating satisfaction with WLB and career plans between October 2012 and March 2013. The sample included equal numbers of men and women from all career stages. Of 2,998 oncologists contacted, 1,490 (49.7%) returned surveys. From 1,117 oncologists (37.3% of overall sample) completing full-length surveys, we evaluated satisfaction with WLB and career plans among the 1,058 who were not yet retired. The proportion of oncologists satisfied with WLB (n = 345; 33.4%) ranked lower than that reported for all other medical specialties in a recent national study. Regarding career plans, 270 oncologists (26.5%) reported a moderate or higher likelihood of reducing their clinical work hours in the next 12 months, 351 (34.3%) indicated a moderate or higher likelihood of leaving their current position within 24 months, and 273 (28.5%) planned to retire before 65 years of age. Multivariable analyses found women oncologists (odds ratio [OR], 0.458; P hour, 0.977; P work hours and leave current position on multivariable analysis. Satisfaction with WLB among US oncologists seems lower than for other medical specialties. Dissatisfaction with WLB shows a strong relationship with plans to reduce hours and leave current practice. Given the pending US oncologist shortage, additional studies exploring interactions among WLB, burnout, and career satisfaction and their impact on career and retirement plans are warranted.

Closing the patient-oncologist communication gap: a review of historic and current efforts.

Science.gov (United States)

Pham, A Khoa; Bauer, Marianne T; Balan, Stefan

2014-03-01

Effective communication is essential in developing any relationship--this is particularly true between oncologists and their patients. The patient-oncologist relationship is one of the most delicate in medicine, and given the strong emotions associated with cancer, successful communication plays a paramount role in the wellbeing of patients and oncologists. Significant advances to close the communication gap have occurred over the past several decades, largely by addressing deficiencies in the various stages of an oncologist's lengthy training: undergraduate medical education, residency and fellowship, and continuing medical education. Stemming from several milestones achieved by highly motivated groups of individuals, including the creation of consensus statements and guidelines by communication education experts, progress has been made to improve patient-oncologist communication. This progress is marked by the development of evidence-based communication skills training programs, such as Oncotalk and Comskil, in addition to the creation of distant-learning modalities, such as the Studying Communication in Oncologist-Patient Encounters trial. This review article outlines the history of communication education during medical education and training, and brings to light more recent efforts to promote competent, communication-minded physicians necessary for effective cancer care.

Oncologists' strategies and barriers to effective communication about the end of life.

Science.gov (United States)

Granek, Leeat; Krzyzanowska, Monika K; Tozer, Richard; Mazzotta, Paolo

2013-07-01

Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues.

Education of Radiation Oncologists. Chapter 15

International Nuclear Information System (INIS)

Rosenblatt, E.; Leer, J.W.; Haffty, B.

2017-01-01

The availability of trained staff in adequate numbers is one of the main obstacles to the development of modern radiotherapy in developing countries. While radiation oncologists practising in affluent environments may not be aware of this reality, limited number of positions, low wages, limited access to sources of evidence and ‘brain drain’ are common in countries with limited resources. Epidemiological predictions of an increase in the crude incidence of cancer that will affect predominantly developing countries represent an alarming situation in which the countries that will face the steepest increase are those most poorly prepared to cope with it. Modern cancer radiotherapy is characterized by team work in which different professionals have different roles and responsibilities. The radiation oncologist is the physician who has been trained to participate in diagnosis, staging, prescription of the radiotherapy dose and patient follow-up.

Obituary: Helen Dodson Prince, 1905-2002

Science.gov (United States)

Lindner, Rudi Paul

2009-01-01

Helen Dodson Prince, a pioneer in the observation of solar flares, a pioneer in women's rise in the profession of astronomy, and a respected and revered educator of future astronomers, died on 4 February 2002 in Arlington, Virginia. Helen Dodson was born in Baltimore, Maryland, on 31 December 1905. Her parents were Helen Walter and Henry Clay Dodson. Helen went to Goucher College in nearby Towson with a full scholarship in mathematics. She turned to astronomy under the influence of a legendary teacher, Professor Florence P. Lewis, and she graduated in 1927. Funded by grants and private charity, she earned the Ph.D. in astronomy at the University of Michigan under the direction of Heber Doust Curtis in 1933. Dodson taught at Wellesley College from 1933 until 1943, when she went on leave to spend the last three years of World War II at the MIT Radiation Laboratory. She returned to Goucher after the war as professor of astronomy and mathematics, and in 1947 she came back to Michigan both as professor of astronomy and staff member of the McMath-Hulbert Observatory, of which she became associate director. In 1976 she retired from Michigan and spent her later years in Alexandria, Virginia. In 1932 Dodson held the Dean Van Meter fellowship from Goucher; in 1954 she received the Annie Jump Cannon Prize from the AAS; and in 1974 The University of Michigan honored her with its Faculty Distinguished Achievement Award. She published over 130 articles, mostly on her research specialty, solar flares. Dodson's interest in the Sun began at Michigan, although her dissertation was, like so many Michigan dissertations of the era, on stellar spectroscopy, "A Study of the Spectrum of 25 Orionis." She came to Michigan during the establishment and growth of the solar observatory at Lake Angelus, the creation of three gifted and industrious amateurs. Heber Curtis fostered the growth of the McMath-Hulbert enterprise and brought it into the University. Dodson's solar activity grew as a

Storia di un Vulcano I GPS di Trimble per monitorare Mount St. Helen

Directory of Open Access Journals (Sweden)

Edoardo Carlucci

2005-10-01

Full Text Available Venticinque anni fa il peggior disastro vulcanico nella storia degli Stati Uniti attirò l’attenzione di tutto il mondo. L’esplosione, preceduta da un paio di mesi di piccole scosse di terremoto, squarciò il fianco Nord del vulcano St. Helens il 18 maggio 1980, provocando allo stesso tempo il più grande smottamento della storia. L’eruzione seguente all’esplosione cancellò tutta l’area circostante, facendo 57 vittime tra la popolazione e formando un profondo cratere a forma di ferro di cavallo; per sei anni si susseguirono altre piccole eruzioni che portarono alla formazione di un’altra cupola lavica dopodiché Loo-wit (il Guardiano del Fuoco, come i nativi americani usavano chiamare il vulcano St. Helens, si addormentò di nuovo. Prima del fatidico giorno Mount St. Helens era la nona cima per altezza negli Stati Uniti; dopo il 18 maggio essa diventava la trentesima.

The "Unsavory Researches" of Helen Campbell: A 19th-Century Journalist's Investigation of Urban Women's Poverty.

Science.gov (United States)

Henry, Susan

In 1886, the New York "Tribune" ran a series of articles by Helen Campbell, "The Prisoners of Poverty," which investigated the sufferings of working women in New York's slums. Initially a fiction and housekeeping writer, Helen Campbell's home economics orientation first pointed her toward the problems of the poor. In the late…

How Radiation Oncologists Would Disclose Errors: Results of a Survey of Radiation Oncologists and Trainees

International Nuclear Information System (INIS)

Evans, Suzanne B.; Yu, James B.; Chagpar, Anees

2012-01-01

Purpose: To analyze error disclosure attitudes of radiation oncologists and to correlate error disclosure beliefs with survey-assessed disclosure behavior. Methods and Materials: With institutional review board exemption, an anonymous online survey was devised. An email invitation was sent to radiation oncologists (American Society for Radiation Oncology [ASTRO] gold medal winners, program directors and chair persons of academic institutions, and former ASTRO lecturers) and residents. A disclosure score was calculated based on the number or full, partial, or no disclosure responses chosen to the vignette-based questions, and correlation was attempted with attitudes toward error disclosure. Results: The survey received 176 responses: 94.8% of respondents considered themselves more likely to disclose in the setting of a serious medical error; 72.7% of respondents did not feel it mattered who was responsible for the error in deciding to disclose, and 3.9% felt more likely to disclose if someone else was responsible; 38.0% of respondents felt that disclosure increased the likelihood of a lawsuit, and 32.4% felt disclosure decreased the likelihood of lawsuit; 71.6% of respondents felt near misses should not be disclosed; 51.7% thought that minor errors should not be disclosed; 64.7% viewed disclosure as an opportunity for forgiveness from the patient; and 44.6% considered the patient's level of confidence in them to be a factor in disclosure. For a scenario that could be considerable, a non-harmful error, 78.9% of respondents would not contact the family. Respondents with high disclosure scores were more likely to feel that disclosure was an opportunity for forgiveness (P=.003) and to have never seen major medical errors (P=.004). Conclusions: The surveyed radiation oncologists chose to respond with full disclosure at a high rate, although ideal disclosure practices were not uniformly adhered to beyond the initial decision to disclose the occurrence of the error.

Helen Howitt: una semilla canadiense en la enfermería latinoamericana Helen Howitt: uma semente canadense na enfermagem latino-americana Helen Howitt: A Canadian seed in Latin American nursing

Directory of Open Access Journals (Sweden)

ANA LUISA VELANDIA MORA

2009-07-01

Full Text Available Este trabajo se propone hacer visible la presencia de Helen Howitt en la enfermería latinoamericana. Paralelamente pretende hacer un análisis de la influencia política del Servicio Cooperativo Interamericano de Salud Pública en la enfermería de la región y la presencia de organizaciones religiosas, especialmente norteamericanas, en varios países latinoamericanos. Helen Howitt, enfermera canadiense egresada de la Universidad de Alberta, fue enviada en 1942 por la Organización Panamericana de la Salud, OPS para que asesorara en Colombia al Ministerio de Trabajo, Higiene y Previsión Social. Pasó a formar parte del proyecto de apertura y organización de la Escuela Nacional Superior de Enfermeras, y fue su primera directora. Helen Howitt fue directora de la Escuela de Enfermería del Hospital Santo Tomás de la Zona del Canal de Panamá entre 1933 y 1938, luego fundadora y primera directora de la Escuela Nacional Superior de Enfermeras de Colombia entre los años 1943 y 1951; posteriormente de la Escuela Nacional de Enfermeras de Bolivia entre 1953 y 1959, cuando fue invitada a cumplir un cargo similar en Venezuela. A todos estos países llegó primero como consultora del respectivo Ministerio de Salud, a través de convenios con el Servicio Cooperativo Interamericano de Salud Pública. La Fundación Rockefeller daba becas para todos los países latinos. En la Escuela del Hospital Santo Tomás de Panamá había estudiantes de toda la América Central, Venezuela, Colombia, hasta del Ecuador y la Argentina. La Rockefeller quería unificar la enfermería en toda Latinoamérica. Llegó primero a Venezuela; y las enfermeras que se graduaron en Panamá fueron las líderes en América Latina, donde trataron de fundar escuelas.O presente trabalho pretende visibilizar a presença de Hellen Howitt na enfermagem latino-americana. Paralelamente, procura fazer uma análise sobre a influência política do Serviço Cooperativo Interamericano de Sa

Helen Howitt: una semilla canadiense en la enfermería latinoamericana Helen Howitt: A Canadian seed in Latin American nursing Helen Howitt: uma semente canadense na enfermagem latino-americana

Directory of Open Access Journals (Sweden)

VELANDIA MORA ANA LUISA

2009-07-01

Full Text Available Este trabajo se propone hacer visible la presencia de Helen Howitt en la enfermería latinoamericana. Paralelamente pretende hacer un análisis de la influencia política del Servicio Cooperativo Interamericano de Salud Pública en la enfermería de la región y la presencia de organizaciones religiosas, especialmente norteamericanas, en varios países latinoamericanos. Helen Howitt, enfermera canadiense egresada de la Universidad de Alberta, fue enviada en 1942 por la Organización Panamericana de la Salud, OPS para que asesorara en Colombia al Ministerio de Trabajo, Higiene y Previsión Social. Pasó a formar parte del proyecto de apertura y organización de la Escuela Nacional Superior de Enfermeras, y fue su primera directora. Helen Howitt fue directora de la Escuela de Enfermería del Hospital Santo Tomás de la Zona del Canal de Panamá entre 1933 y 1938, luego fundadora y primera directora de la Escuela Nacional Superior de Enfermeras de Colombia entre los años 1943 y 1951; posteriormente de la Escuela Nacional de Enfermeras de Bolivia entre 1953 y 1959, cuando fue invitada a cumplir un cargo similar en Venezuela. A todos estos países llegó primero como consultora del respectivo Ministerio de Salud, a través de convenios con el Servicio Cooperativo Interamericano de Salud Pública. La Fundación Rockefeller daba becas para todos los países latinos. En la Escuela del Hospital Santo Tomás de Panamá había estudiantes de toda la América Central, Venezuela, Colombia, hasta del Ecuador y la Argentina. La Rockefeller quería unificar la enfermería en toda Latinoamérica. Llegó primero a Venezuela; y las enfermeras que se graduaron en Panamá fueron las líderes en América Latina, donde trataron de fundar escuelas.This work's purpose is to make more visible Hellen Howitt's presence in Latin American nursing. At the same time it pretends to make an analysis on the political influence of the Interamerican Cooperative Public

All eyes on the patient: the influence of oncologists? nonverbal communication on breast cancer patients? trust

OpenAIRE

Hillen, Marij A.; de Haes, Hanneke C. J. M.; van Tienhoven, Geertjan; Bijker, Nina; van Laarhoven, Hanneke W. M.; Vermeulen, Dani?lle M.; Smets, Ellen M. A.

2015-01-01

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients? trust. We were the first to experimentally examine (1) how the oncologist?s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients? trust. Analogue patients (APs) viewed one out of eight vers...

Seeking informed consent to Phase I cancer clinical trials: identifying oncologists' communication strategies.

Science.gov (United States)

Brown, Richard; Bylund, Carma L; Siminoff, Laura A; Slovin, Susan F

2011-04-01

Phase I clinical trials are the gateway to effective new cancer treatments. Many physicians have difficulty when discussing Phase I clinical trials. Research demonstrates evidence of suboptimal communication. Little is known about communication strategies used by oncologists when recruiting patients for Phase I trials. We analyzed audio recorded Phase I consultations to identify oncologists' communication strategies. Subjects were consecutive cancer patients from six medical oncologists attending one of three outpatient clinics at a major Cancer Center in the United States. Sixteen patients signed informed consent for audio recording of their consultations in which a Phase I study was discussed. These were transcribed in full and analyzed to identify communication strategies. Six communication themes emerged from the analysis: (1) orienting, (2) educating patients, (3) describing uncertainty and prognosis, (4) persuading, (5) decision making, and (6) making a treatment recommendation. As expected, although there was some common ground between communication in Phase I and the Phase II and III settings, there were distinct differences. Oncologists used persuasive communication, made explicit recommendations, or implicitly expressed a treatment preference and were choice limiting. This highlights the complexity of discussing Phase I trials and the need to develop strategies to aid oncologists and patients in these difficult conversations. Patient centered communication that values patient preferences while preserving the oncologist's agenda can be a helpful approach to these discussions. Copyright © 2010 John Wiley & Sons, Ltd.

Differences in oncologist communication across age groups and contributions to adjuvant decision outcomes.

Science.gov (United States)

Step, Mary M; Siminoff, Laura A; Rose, Julia H

2009-11-01

The objective of this study was to assess potential age-related differences in oncologist communication during conversations about adjuvant therapy decisions and subsequent patient decision outcomes. Communication was observed between a cross-section of female patients aged 40 to 80 with early-stage breast cancer (n=180) and their oncologists (n=36) in 14 academic and community oncology practices in two states. Sources of data included audio recordings of visits, followed by post-visit patient interviews. Communication during the visit was assessed using the Siminoff Communication Content and Affect Program. Patient outcome measures included self-reported satisfaction with decision, decision conflict, and decision regret. Results showed that oncologists were significantly more fluent and more direct with older than middle-aged patients and trended toward expressing their own treatment preferences more with older patients. Satisfaction with treatment decisions was highest for women in their 50s and 60s. Decision conflict was significantly associated with more discussion of oncologist treatment preferences and prognosis. Decision regret was significantly associated with patient age and education. Older adults considering adjuvant therapy may find that oncologists' communication accommodations to perceived deficiencies in older adult cognition or communication challenge their decision-making involvement. Oncologists should carefully assess patient decision-making preferences and be mindful of accommodating their speech to age-related stereotypes.

Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study.

Science.gov (United States)

Park, Ji-Hye; Oh, Minsuk; Yoon, Yong Jin; Lee, Chul Won; Jones, Lee W; Kim, Seung Il; Kim, Nam Kyu; Jeon, Justin Y

2015-04-10

The purpose of the present study was to examine 1) characteristics and attitudes of oncologists toward exercise and toward recommending exercise to their patients, 2) association among oncologists' own physical activity levels, exercise recommendations, and their attitudes toward recommending exercise. A total of 167 oncologists participated in this survey study (41 surgeons, 78 medical oncologists, 25 radiation oncologists, and 21 others). Most oncologists included in the study treat more than one type of cancer, including colorectal, gastric, breast, lung, and liver cancer. To analyze the data, the one-way ANOVA, and t-test were used. All data were indicated for mean, SD, and proportions. Most oncologists agreed that exercise is beneficial (72.8%) and important (69.6%), but only 39.2% of them agreed that exercise is safe, and only 7.2% believed that cancer patients manage to exercise during cancer treatment. Forty-six percentage of the surveyed oncologists recommended exercise to their patients during the past month. The average amount of participation in physical activity by oncologists who participated in the study was 139.5 ± 120.3 min per week, and 11.4% of the study participants met the American College of Sports Medicine (ACSM) guidelines. Oncologists' own physical activity levels were associated with their attitudes toward recommending exercise. Belief in the benefits of exercise in the performance of daily tasks, improvement of mental health, and the attenuation of physical decline from treatment were the three most prevalent reasons why oncologists recommend exercise to their patients. Barriers to recommending exercise to patients included lack of time, unclear exercise recommendations, and the safety of patients. Oncologists have favorable attitudes toward exercise and toward recommending exercise to their patients during treatment. However, they also experience barriers to recommending exercise, including lack of time, unclear exercise guidelines

Knowledge, attitudes and awareness regarding fertility preservation among oncologists and clinical practitioners in Lebanon.

Science.gov (United States)

Ghazeeri, Ghina; Zebian, Dina; Nassar, Anwar H; Harajly, Sally; Abdallah, Alain; Hakimian, Stephanie; Skaiff, Bassem; Abbas, Hussein A; Awwad, Johnny

2016-06-01

Fertility preservation (FP) aims to help individuals overcome the infertility associated with cancer treatments such as chemotherapy and radiation. The objective of this study was to assess the awareness, attitudes and knowledge of oncologists' and clinical practitioners' (CPs) about fertility preservation and its options in Lebanon. This was a cross-sectional study with surveys carried out between March 2012 and February 2013 on CPs at the American University of Beirut Medical Centre and Saint Jude's Children Cancer Centre as well as all registered oncologists in Lebanon. Ninety percent of CPs (n = 88) and 94% of oncologists (n = 53) agreed that fertility preservation should be discussed with patient before their cancer treatment. Our data showed a gender bias in relation to patients being informed of their FP options, as well as conflicting knowledge of FP options available in Lebanon among oncologists. The CPs were more likely to have accurate knowledge of FP options and treatment than oncologists. A proactive approach is required to: (1) increase the awareness and knowledge of FP; (2) improve attitudes towards FP; and (3) encourage its communication between CPs, oncologists and patients in Lebanon. Increased education programs, awareness campaigns and development of dedicated FP centres are needed.

Discrepant Views of Oncologists and Cancer Patients on Complementary and Alternative Medicine in a Chinese General Hospital.

Science.gov (United States)

Yang, Geliang; Zhang, Huiqing; Gan, Zheng; Fan, Yifu; Gu, Wei; Ling, Changquan

2018-06-01

Complementary and alternative medicine (CAM) has been widely used by cancer patients but rarely discussed by oncologists. This study was designed to evaluate the communication gap between China's oncologists and cancer patients on CAM. Two parallel cross-sectional studies assessed 83 oncologists and 402 cancer patients on CAM communication between patients and oncologists, and attitudes toward CAM use and clinical decisions about CAM. A majority (75.1%) of the cancer patients (302/402) were identified as CAM users within the most recent three months while 77.6% of the cancer patients (312/402) were identified as CAM users since diagnosis of cancer. Oncologists and patients responded differently ( P effectiveness of CAM, cancer patients were more likely to believe that CAM was effective while oncologists had more concerns about adverse effects of CAM use. CAM use by patients was predicted by disease duration (≥9 months) in the multivariable logistic regression model. China's oncologists and cancer patients may hold discrepant views on CAM. China's oncologists are encouraged to improve their knowledge on CAM and to initiate more discussions with their patients regarding effective and the safe use of CAM.

Large-amplitude traveling ionospheric distrubance produced by the May 18, 1980, explosion of Mount St. Helens

International Nuclear Information System (INIS)

Roberts, D.H.; Klobuchar, J.A.; Fougere, P.F.; Hendrickson, D.H.

1982-01-01

A remarkable long-lived, large-scale traveling ionospheric disturbance (TID), excited by the May 18, 1980, explosion of Mount St. Helens, has been detected in total electron content monitor data. Oscillatory perturbations in the electron column density of the ionosphere with amplitudes about 10% of the nominal daytime content were detected at three stations whose ionospheric penetration points lie between 1610 and 1890 km from Mount St. Helens. Smaller perturbations were detected at five of six additional stations between 3760 and 4950 km away. The period of the TID increased linearly with great-circle distance from Mount St. Helens, ranging from roughly-equal37 min at the nearest station to roughly-equal116 min at the most distant one. The TID persisted for at least four cycles at the three close stations and three cycles at the more distant stations and was qualitatively similar to TID's produced by the low-altitude thermonuclear detonations of the 1960's. The disturbance front of this TID accelerated from an average velocity of roughly-equal350 m/s between Mt. St. Helens and the close stations to an average velocity of roughly-equal550 m/s to the more distant ones.A model based on the free wave response of an isothermal atmosphere to a point disturbance provides a good fit to the data at the three closest stations, but no such model can account for all of the data. Modeling of the long-distance behavior of the Mount St. Helens TID in terms of upper-atmosphere guided gravity waves is complicated by the requirement of exciting them by a ground-level explosion. There was no evidence for a strong supersonic shock wave in the ionosphere. As a result, the Mount St. Helens disturbance may prove to be a cleaner test of detailed theories of the point excitation and propagation of gravity waves in a realistic atmosphere than were TID's excited by thermonuclear weapons

How attachment style and locus of control influence patients' trust in their oncologist

NARCIS (Netherlands)

Hillen, Marij A.; de Haes, Hanneke C. J. M.; Stalpers, Lukas J. A.; Klinkenbijl, Jean H. G.; Eddes, Eric-Hans; Verdam, Mathilde G. E.; Smets, Ellen M. A.

2014-01-01

Cancer patients need to trust their oncologist. How the oncologist communicates probably contributes to patients' trust. Yet, patient characteristics such as their attachment style and health locus of control may influence how such communication is perceived. We examined how these personality

How attachment style and locus of control influence patients' trust in their oncologist

NARCIS (Netherlands)

Hillen, M.A.; de Haes, H.C.J.M.; Stalpers, L.J.A.; Klinkenbijl, J.H.G.; Eddes, E.-H.; Verdam, M.G.E.; Smets, E.M.A.

2014-01-01

Objective: Cancer patients need to trust their oncologist. How the oncologist communicates probably contributes to patients' trust. Yet, patient characteristics such as their attachment style and health locus of control may influence how such communication is perceived. We examined how these

The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group.

Science.gov (United States)

Shanafelt, Tait D; Novotny, Paul; Johnson, Mary E; Zhao, Xinghua; Steensma, David P; Lacy, Martha Q; Rubin, Joseph; Sloan, Jeff

2005-01-01

The well-being of oncologists is important to the well-being of their patients. While much is known about oncologist distress, little is known about oncologist well-being. We set out to evaluate oncologist well-being and the personal wellness promotion strategies used by oncologists. We performed a cross-sectional survey of medical oncologists in the North Central Cancer Treatment Group using a validated instrument to measure quality of life. Study-specific questions explored stressors, wellness promotion strategies and career satisfaction. Of 241 responding oncologists (response rate 61%), 121 (50%) reported high overall well-being. Being age 50 or younger (57 vs. 41%; p = 0.01), male (53 vs. 31%; p = 0.01) and working 60 h or less per week (50 vs. 33%; p = 0.005) were associated with increased overall well-being on bivariate analysis. Ratings of the importance of a number of personal wellness promotion strategies differed for oncologists with high well-being compared with those without high well-being. Developing an approach/philosophy to dealing with death and end-of-life care, using recreation/hobbies/exercise, taking a positive outlook and incorporating a philosophy of balance between personal and professional life were all rated as substantially more important wellness strategies by oncologists with high well-being (p values career satisfaction. Half of medical oncologists experience high overall well-being. Use of specific personal wellness promotion strategies appears to be associated with oncologist well-being. Further investigations of the prevalence, promotion, causes, inequities and clinical impact of physician well-being are needed. .

Grief symptoms and difficult patient loss for oncologists in response to patient death.

Science.gov (United States)

Granek, Leeat; Ben-David, Merav; Shapira, Shahar; Bar-Sela, Gil; Ariad, Samuel

2017-07-01

The study aimed to explore oncologist's grief symptoms over patient death and to identify why and which losses are particularly challenging when patients die. The grounded theory method was used to collect and analyze the data. Twenty-two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers in the north, center, and south of Israel. Oncologists were at different stages of their careers and varied in their sub-specialties, gender, and personal and professional backgrounds. Grief begun when the patient died, in anticipation of the patient's death, many days after the death, or when the patient received a poor prognosis. The phenomenological experience of grief for oncologists included behavioral, cognitive, physical, and emotional symptoms in response to patient death. Behavioral symptoms included crying and difficulties sleeping. Cognitive symptoms included self-doubt and rumination about the patient and the care the patient had received before death. Physical symptoms included chest pain, fatigue, and general physical discomfort. Emotional symptoms included sadness, anxiety, helplessness, guilt, relief, irritability, and loss. Difficult patient loss was caused by patient-related factors, family-related factors, and disease-related factors. Patient deaths result in behavioral, cognitive, physical, and emotional symptoms of grief in oncologists. These symptoms become particularly intense in the context of patient, family, and disease-related factors. Educational and supportive interventions for managing grief related to patient death are needed in order to support oncologists in their emotionally and mentally taxing work. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Mount St. Helens 30 years later: a landscape reconfigured.

Science.gov (United States)

Rhonda Mazza

2010-01-01

On May 18, 1980, after two months of tremors, Mount St. Helens erupted spectacularly and profoundly changed a vast area surrounding the volcano. The north slope of the mountain catastrophically failed, forming the largest landslide witnessed in modern times. The largest lobe of this debris avalanche raced 14 miles down the Toutle River...

Colonos y soldados en Oriente Helenístico

Directory of Open Access Journals (Sweden)

Adolfo Domínguez Monedero

1994-01-01

Full Text Available Este artículo estudia las formas que asume el asentamiento de soldados en el mundo helenístico. En primer lugar, se estudia la época de Alejandro Magno en cuanto que precedente; en efecto, Alejandro ha utilizado en gran medida a sus soldados para fundar nuevas colonias, que son un medio de proteger y defender sus conquistas. Este procedimiento ha sido igualmente empleado por sus sucesores, los reyes helenísticos. Aquí estudio ante todo los reinos Seiéucida y Tolemaico, haciendo especial hincapié en los diferentes métodos de los que cada uno de ellos se ha servido, y los distintos fines que debía alcanzar cada una de sus respectivas políticas de asentamiento. Del mismo modo, en cada uno de los tres casos abordados me detengo ante todo en las relaciones entre macedonios, griegos, indígenas y no griegos en general en las nuevas fundaciones. Como conclusión, se resalta el sentido general de todo el proceso en la conformación del mundo helenístico.This paper analyzes the ways in which the settlement of soldiers has been accomplished in the Hellenistic world. Firstly, I study the age of Alexander the Great as a precedent; Alexander has greatly used his soldiers in the foundation of new colonies as a way to protect and defend his conquests. This procedure has been also used by his successors, the Hellenistic kings. I study mainly the Seleucid and the Ptolemaic Kingdoms, stressing the different ways each of them has used, and the different purposes of their different settiement politics. In the three cases deait the relations between Macedonians, Greeks, Natives and non-greeks in general in the new foundations are underlined. As a conclusión the overall meaning of all the process in the shaping of the Hellenistic worid is emphasized.

25 years of ecological change at Mount St. Helens.

Science.gov (United States)

V.H. Dale; C.M. Crisafulli; F.J. Swanson

2005-01-01

18 May 2005 marks the 25th anniversary of the massive eruption of Mount St. Helens. This eruption involved diverse geological processes (1) that disturbed forests, meadows, lakes, an drivers (2) (see the figure). A huge landslide and searing flows of hot gases and pumic framents (pyroclastic flows) inundated 60 km2 of land, obliterating...

Proximal ecological effects of the 1980 eruptions of Mount St. Helens

Science.gov (United States)

Swanson, F. J.

1988-01-01

The diversity of ecosystems and volcanic processes involved in the 1980 eruptions of Mount St. Helens, southwest Washington, provide an excellent setting for examining effects of volcanic events on ecosystems. These eruptions included a lateral blast, debris avalanche, mudflows, pyroclastic flows, and airfall tephra. Affected ecosystems within 30 km of the vent were lakes, streams, upland and riparian forest, and meadows. Ecological disturbances imposed by the Mount St. Helens events were predominantly physical, rather than climatic or chemical which are the dominant classes of disturbances considered in analysis of global catastrophes. Analysis of ecosystem response to disturbance should be based on consideration of composition and structure of the predisturbance system in terms that represent potential survivability of organisms, mechanisms in the primary disturbance, initial survivors, secondary disturbances arising from the primary disturbance and the biological responses to secondary disturbances, invasion of the site by new propagules, interactions among secondary disturbance processes and surviving and invading organisms. Predicting ecosystem response to disturbance is enchanced by considering the mechanisms of disturbance rather than type of disturbance. In the 1980 Mount St. Helens events, the disturbance types, involved primarily the mechanisms of sedimentation, heating, and shear stress. Each disturbance type involved one or more mechanisms. Ecosystem response varied greatly across the landscape. Analysis of ecosystem response to disturbance, regardless of type, should include detailed consideration of the properties of individual species, primary and secondary disturbance mechanisms, and their distributions across landscapes.

Mount St. Helens: Still erupting lessons 31 years later

Science.gov (United States)

Rhonda Mazza; Charlie Crisafulli; Fred Swanson

2011-01-01

The massive volcanic eruption of Mount St. Helens 31 years ago provided the perfect backdrop for studying the earliest stages of forest development. Immediately after the eruption, some areas of the blast area were devoid of life. On other parts of the volcanic landscape, many species survived, although their numbers were greatly reduced. Reassembly began at many...

Balti aadlipreili kunstiharrastusest : Helene Marie Zoege von Manteuffel (1773/74-1842) = Artistic pursuits of an aristocratic Baltic lady : Helene Marie Zoege von Manteuffel (1773/74-1842) / Kadi Polli

Index Scriptorium Estoniae

Polli, Kadi, 1973-

2014-01-01

Aadlitüdrukute haridusest ja kunstiharidusest Balti valgustusaja kunsti(haridus)maastikul. Perekond Zoege von Manteuffeli kunstilembusest ja Ojasoo mõisa tähtsusest baltisaksa kunstiajaloos. Helene Mariest Franz Gerhard Kügelgeni õpilasena ja abikaasana

Helen Mirren võitis Elizabeth II rolliga brittide Oscari / Triin Tael

Index Scriptorium Estoniae

Tael, Triin

2007-01-01

Stephen Frearsi mängufilmis "Kuninganna" ("The Queen") kuninganna Elizabeth II kehastav Helen Mirren sai oma rolli eest parima naisnäitleja Bafta (Briti filmiakadeemia auhind). Linateos pälvis ka aasta parima filmi tiitli. Ka teistest võitjatest

All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust.

Science.gov (United States)

Hillen, Marij A; de Haes, Hanneke C J M; van Tienhoven, Geertjan; Bijker, Nina; van Laarhoven, Hanneke W M; Vermeulen, Daniëlle M; Smets, Ellen M A

2015-08-01

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients' trust. We were the first to experimentally examine (1) how the oncologist's nonverbal behavior influences trust, and (2) individual differences in breast cancer patients' trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist's amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = -.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (rs = .31, p < .001) and caring (rs = .18, p = .01). Older (β = .17, p = .01) and lower educated APs (β = -.25, p < .001) were more trusting. Trust was weaker for more avoidantly attached APs (β = -.16, p = .03). We experimentally demonstrated the importance of maintaining consistent eye contact for breast cancer patients' trust, especially among lower educated patients. These findings need to be translated into training for oncologists in how to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation.

Satellite sar detection of hurricane helene (2006)

DEFF Research Database (Denmark)

Ju, Lian; Cheng, Yongcun; Xu, Qing

2013-01-01

In this paper, the wind structure of hurricane Helene (2006) over the Atlantic Ocean is investigated from a C-band RADARSAT-1 synthetic aperture radar (SAR) image acquired on 20 September 2006. First, the characteristics, e.g., the center, scale and area of the hurricane eye (HE) are determined. ...... observations from the stepped frequency microwave radiometer (SFMR) on NOAA P3 aircraft. All the results show the capability of hurricane monitoring by satellite SAR. Copyright © 2013 by the International Society of Offshore and Polar Engineers (ISOPE)....

American Society of Clinical Oncology Policy Statement: The Role of the Oncologist in Cancer Prevention and Risk Assessment

Science.gov (United States)

Zon, Robin T.; Goss, Elizabeth; Vogel, Victor G.; Chlebowski, Rowan T.; Jatoi, Ismail; Robson, Mark E.; Wollins, Dana S.; Garber, Judy E.; Brown, Powel; Kramer, Barnett S.

2009-01-01

Oncologists have a critical opportunity to utilize risk assessment and cancer prevention strategies to interrupt the initiation or progression of cancer in cancer survivors and individuals at high risk of developing cancer. Expanding knowledge about the natural history and prognosis of cancers positions oncologists to advise patients regarding the risk of second malignancies and treatment-related cancers. In addition, as recognized experts in the full spectrum of cancer care, oncologists are afforded opportunities for involvement in community-based cancer prevention activities. Although oncologists are currently providing many cancer prevention and risk assessment services to their patients, economic barriers exist, including inadequate or lack of insurance, that may compromise uniform patient access to these services. Additionally, insufficient reimbursement for existing and developing interventions may discourage patient access to these services. The American Society of Clinical Oncology (ASCO), the medical society representing cancer specialists involved in patient care and clinical research, is committed to supporting oncologists in their wide-ranging involvement in cancer prevention. This statement on risk assessment and prevention counseling, although not intended to be a comprehensive overview of cancer prevention describes the current role of oncologists in risk assessment and prevention; provides examples of risk assessment and prevention activities that should be offered by oncologists; identifies potential opportunities for coordination between oncologists and primary care physicians in prevention education and coordination of care for cancer survivors; describes ASCO's involvement in education and training of oncologists regarding prevention; and proposes improvement in the payment environment to encourage patient access to these services. PMID:19075281

Isocrates’ Encomium of Helen: Reply to Gorgias and the Unicity of his Epideictic Discourse

Directory of Open Access Journals (Sweden)

Ticiano Curvelo Estrela de Lacerda

2017-06-01

Full Text Available Around 390-80 BC, the Athenian Isocrates composed one of his first speeches as an educator, the Helen. According to most scholars, this speech seems to be a replica to the famous Eulogy of Helen by Gorgias, which, according to Isocrates (§14, would have made not an encomium, but an apology on behalf of the Spartan queen. In the Isocratic encomium, we noticed some dissonance between the proemium and the rest of the work. In fact, we do not have in the proemium the expected laudatory tone, but it is configured, on the contrary, as an invective to sophists groups contemporary of Isocrates, and culminates in the end with an allusive criticism of the Leontine sophist. Thus, what the IV century BC sophists have in common with the mythical Helen? In other words, would there be a common thread that would ensure a discursive unity in that epideictic exercise of Isocrates? This study aims to discuss these issues and review how they are being discussed by some commentators of Isocrates, since the Rhetoric of Aristotle to the reception of the matter among some scholars of Classical Rhetoric in the XX century.

Nuclear disasters: current plans and future directions for oncologists.

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Goffman, Thomas E

2008-01-01

To show that there is a significant role for oncologists in the event of a terrorist nuclear disaster. Professionals need data on current political issues regarding a nuclear attack already put in place by the administration and the military. Review of what actually occurs during a fission bomb's explosion helps to point out what medical care will be most needed. The author contends that those trained in the oncologies could play a major part. Modern-day America. Potential civilian survivors. Large gaps noted in statewide disaster plans in the public domain. Oncologists must get involved now in disaster planning; statewide plans are necessary throughout the nation; the public needs to know the basics of what to do in the advent of a nuclear bomb explosion.

Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

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Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L

2017-07-01

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment. © 2017 John Wiley & Sons Ltd.

Satisfaction with work-life balance among U.S. gynecologic oncologists, a cross-sectional study

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Szender, J Brian; Grzankowski, Kassondra S; Eng, Kevin H; Lele, Shashikant B; Odunsi, Kunle; Frederick, Peter J

2016-01-01

Objectives To evaluate the satisfaction with work-life balance (WLB) and career satisfaction of gynecologic oncologists. Methods In August 2014, members of the Society of Gynecologic Oncology (SGO) were sent an anonymous, cross-sectional survey evaluating demographic variables, practice characteristics, career satisfaction, fatigue, and satisfaction with WLB. Fatigue was assessed using a visual-analog scale. Career satisfaction and WLB were assessed with a Likert scale. Inferential statistics were computed with type I error rates of 0.05. Results Out of the 1002 gynecologic oncologists surveyed, 290 (28.9%) responded. Only 18.6% of respondents were satisfied with WLB and there were significant associations between gender (P = 0.0157), time spent in work related activities at home (P = 0.0024), on weekends (P = 0.0017), and in the hospital (P = 0.0001). More than 84% of physicians reported they would choose medicine as a career again and of those 90% would choose to be a gynecologic oncologist again. Fatigue was strongly associated with dissatisfaction with WLB in univariate and multivariate analysis (P < 0.0001). Conclusions Although gynecologic oncologists indicated they are satisfied with their careers, most are not satisfied with their WLB. Given the forecast shortage of gynecologic oncologists and projected increased cancer rates, understanding the factors associated with career satisfaction may assist the SGO in meeting future gynecologic cancer care needs. PMID:27088113

Pushing up daisies: implicit and explicit language in oncologist-patient communication about death.

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Rodriguez, Keri L; Gambino, Frank J; Butow, Phyllis; Hagerty, Rebecca; Arnold, Robert M

2007-02-01

Although there are guidelines regarding how conversations with patients about prognosis in life-limiting illness should occur, there are little data about what doctors actually say. This study was designed to qualitatively analyze the language that oncologists and cancer patients use when talking about death. We recruited 29 adults who had incurable forms of cancer, were scheduled for a first-time visit with one of six oncologists affiliated with a teaching hospital in Australia, and consented to having their visit audiotaped and transcribed. Using content analytic techniques, we coded various features of language usage. Of the 29 visits, 23 (79.3%) included prognostic utterances about treatment-related and disease-related outcomes. In 12 (52.2%) of these 23 visits, explicit language about death ("terminal," variations of "death") was used. It was most commonly used by the oncologist after the physical examination, but it was sometimes used by patients or their kin, usually before the examination and involving emotional questioning about the patient's future. In all 23 (100%) visits, implicit language (euphemistic or indirect talk) was used in discussing death and focused on an anticipated life span (mentioned in 87.0% of visits), estimated time frame (69.6%), or projected survival (47.8%). Instead of using the word "death," most participants used some alternative phrase, including implicit language. Although oncologists are more likely than patients and their kin to use explicit language in discussing death, the oncologists tend to couple it with implicit language, possibly to mitigate the message effects.

Tähistame Helen Kelleri 130. sünniaastapäeva

Index Scriptorium Estoniae

Keskküla, Raissa

2010-01-01

Helen Kellerist ja tema sünniaastapäeva tähistamisest, samuti Eesti Pimekurtide Tugiliidu ettevõtmistest: koostöölepingust Eesti Kujurite Ühendusega, punktkirjas väljaantud raamatust "Õppimise ime", Hilton/Perkins programmi kaasabil Eesti pimekurtide ja nägemis-liitpuudega lastega töötavate õpetajate ning töötajate koolitamiset

Volcano ecology: flourishing on the flanks of Mount St. Helens

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Rhonda Mazza; Charlie Crisafulli

2016-01-01

Mount St. Helens’ explosive eruption on May 18, 1980, was a pivotal moment in the field of disturbance ecology. The subsequent sustained, integrated research effort has shaped the development of volcano ecology, an emerging field of focused research. Excessive heat, burial, and impact force are some of the disturbance mechanisms following an eruption. They are also...

Helen M. Walker: Influential in 1929 and Still Cited Today.

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Rice, Marti H.; Stallings, William M.

Helen M. Walker contributed to the field of educational research and statistics during a 55-year career. Born in Iowa in 1891, Walker earned a bachelor's degree from Iowa Wesleyan College and taught high school mathematics for nine years. She then taught at the University of Kansas while doing graduate work. One source noted that she was the first…

All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust

NARCIS (Netherlands)

Hillen, Marij A.; de Haes, Hanneke C. J. M.; van Tienhoven, Geertjan; Bijker, Nina; van Laarhoven, Hanneke W. M.; Vermeulen, Daniëlle M.; Smets, Ellen M. A.

2015-01-01

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients' trust. We were the first to

Quantitative evaluation of radiation oncologists' adaptability to lower reimbursing treatment programs.

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Gill, Beant S; Beriwal, Sushil; Rajagopalan, Malolan S; Wang, Hong; Hodges, Kimberly; Greenberger, Joel S

2015-01-01

Rapid development of sophisticated modalities has challenged radiation oncologists to evaluate workflow and care delivery processes. Our study assesses treatment modality use and willingness to alter management with anticipated limitations in reimbursement and resources. A web-based survey was sent to 43 radiation oncologists in a National Cancer Institute-designated comprehensive cancer center network. The survey contained 7 clinical cases with various acceptable treatment options based on our institutional clinical pathways. Each case was presented in 3 modules with varying situations: (1) unlimited resources with current reimbursement, (2) restricted reimbursement (bundled payment), and (3) both restricted reimbursement and resources. Reimbursement rates were based on the 2013 Medicare fee schedule. Adoption of lower reimbursing options (LROs) was defined as the percentage of scenarios in which a respondent selected an LRO compared with baseline. Forty-three physicians completed the survey, 11 (26%) at academic and 32 (74%) at community facilities. When bundled payment was imposed (module 1 vs 2), an increase in willingness to adopt LROs was observed (median 11.1%). When physicians were limited to both bundled payment and resource restriction, adoption of LROs was more pronounced (module 1 vs 3; median 22.2%, P 25 years, P = .02). Radiation oncologists were more likely to choose lower reimbursing treatment options when both resource restriction and bundled payment were presented. Those with fewer years of clinical practice were less inclined to alter management, perhaps reflecting modern residency training. Future cost-utility analyses may help to better guide radiation oncologists in selection of LROs. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Co-authorship patterns and networks of Korean radiation oncologists

International Nuclear Information System (INIS)

Choi, Jin Hyun; Kang, Jin Oh; Park, Seo Hyun; Kim, Sang Ki

2011-01-01

This research aimed to analyze the patterns of co-authorship network among the Korean radiation oncologists and to identify attributing factors for the formation of networks. A total of 1,447 articles including contents of 'Radiation Oncology' and 'Therapeutic Radiology' were searched from the KoreaMed database. The co-authorship was assorted by the author's full name, affiliation and specialties. UCINET 6.0 was used to figure out the author's network centrality and the cluster analysis, and KeyPlayer 1.44 program was used to get a result of key player index. Sociogram was analyzed with the Netdraw 2.090. The statistical comparison was performed by a t-test and ANOVA using SPSS 16.0 with p-value < 0.05 as the significant value. The number of articles written by a radiation oncologist as the fi rst author was 1,025 out of 1,447. The pattern of coauthorship was classified into fi ve groups. For articles of which the fi rst author was a radiation oncologist, the number of single author articles (type-A) was 81; single-institution articles (type-B) was 687; and multiple-author articles (type-C) was 257. For the articles which radiation oncologists participated in as a co-author, the number of single-institution articles (type-D) was 280 while multiple-institution articles (type-E) were 142. There were 8,895 authors from 1,366 co-authored articles, thus the average number of authors per article was 6.51. It was 5.73 for type-B, 6.44 for type-C, 7.90 for type-D, and 7.67 for type-E (p 0.000) in the average number of authors per article. The number of authors for articles from the hospitals published more than 100 articles was 7.23 while form others was 5.94 (p = 0.005). Its number was 5.94 and 7.16 for the articles published before and after 2001 (p = 0.000). The articles written by a radiation oncologist as the fi rst author had 5.92 authors while others for 7.82 (p = 0.025). Its number was 5.57 and 7.71 for the Journal of the Korean Society for Therapeutic Radiology

What do Patients Want From Their Radiation Oncologist? Initial Results From a Prospective Trial

International Nuclear Information System (INIS)

Bhatnagar, Ajay K.; Land, Stephanie R.; Shogan, Alyson; Rodgers, Edwin E.; Heron, Dwight E.; Flickinger, John C.

2007-01-01

Purpose: To assess patients' initial physician preferences using a newly developed instrument. Methods and Materials: A total of 182 patients with a primary diagnosis of prostate, breast, or lung cancer referred for consultation to University of Pittsburgh Cancer Institute Department of Radiation Oncology enrolled in our institutional review board-approved protocol. All patients completed patient preference instrument surveys before meeting their radiation oncologist. Survey responses to 10 statements were categorized into three groups (agree, neutral, or disagree), and the association of survey responses by cancer site was tested with chi-squared tests. Results: Ninety-nine percent of all patients preferred to be addressed by their first name in encounters with their radiation oncologist. There were significant associations of Item 3 (hand holding) with gender (p = 0.039) and education (p = 0.028). The responses to Item 5, a statement that patients would feel uncomfortable if the radiation oncologist offered to hug them at the end of treatment, was significantly associated with disease site (p < 0.0001). Further analysis was performed for Item 5 and revealed that the male lung cancer patients had a much higher rate of disagreement with Item 5 compared with prostate cancer patients (37% vs. 18%). Conclusions: Results of this study may afford greater insight and foster better understanding of what patients want from their radiation oncologist. For breast, lung, and prostate cancer patients, initial preferences for their radiation oncologist are generally similar, according to this tool. However, there are important difference among cancer sites (and gender) regarding physical contact at the end of treatment

Young adult cancer survivors' follow-up care expectations of oncologists and primary care physicians.

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Hugh-Yeun, Kiara; Kumar, Divjot; Moghaddamjou, Ali; Ruan, Jenny Y; Cheung, Winson Y

2017-06-01

Young adult cancer survivors face unique challenges associated with their illness. While both oncologists and primary care physicians (PCPs) may be involved in the follow-up care of these cancer survivors, we hypothesized that there is a lack of clarity regarding each physician's roles and responsibilities. A self-administered survey was mailed to young adult cancer survivors in British Columbia, Canada, who were aged 20 to 39 years at the time of diagnosis and alive at 2 to 5 years following the diagnosis to capture their expectations of oncologists and PCPs in various important domains of cancer survivorship care. Multivariate logistic regression models that adjusted for confounders were constructed to examine for predictors of the different expectations. Of 722 young cancer survivors surveyed, 426 (59%) responded. Among them, the majority were White women with breast cancer. Oncologists were expected to follow the patient's most recent cancer and treatment-related side effects while PCPs were expected to manage ongoing and future cancer surveillance as well as general preventative care. Neither physician was perceived to be responsible for addressing the return to daily activities, reintegration to interpersonal relationships, or sexual function. Older survivors were significantly less likely to expect oncologists (p = 0.03) and PCPs (p = 0.01) to discuss family planning when compared to their younger counterparts. Those who were White were significantly more likely to expect PCPs to discuss comorbidities (p = 0.009) and preventative care (p = 0.001). Young adult cancer survivors have different expectations of oncologists and PCPs with respect to their follow-up care. Physicians need to better clarify their roles in order to further improve the survivorship phase of cancer care for young adults. Young adult cancer survivors have different expectations of their oncologists and PCPs. Clarification of the roles of each physician group during follow-up can

A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities.

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Shen, Megan Johnson; Binz-Scharf, Maria; D'Agostino, Tom; Blakeney, Natasha; Weiss, Elisa; Michaels, Margo; Patel, Shilpa; McKee, M Diane; Bylund, Carma L

2015-03-15

Research has demonstrated that communication and care coordination improve cancer patient outcomes. To improve communication and care coordination, it is important to understand primary care providers' (PCPs') perceptions of communication with oncologists as well as PCPs' communication needs. A mixed-methods approach was used in the present study. In the qualitative phase of the study, 18 PCPs practicing in underserved, minority communities were interviewed about their experiences communicating with oncologists. In the quantitative phase of the study, 128 PCPs completed an online survey about their preferences, experiences, and satisfaction with communication with oncologists. Results indicated a PCP-oncologist gap in communication occurred between diagnosis and treatment. PCPs wanted more communication with oncologists, updates on their patients' prognosis throughout treatment, and to be contacted via telephone or email and saw their role as crucial in providing supportive care for their patients. Although PCPs recognize that they play a critical, proactive role in supporting patients throughout the continuum of their cancer care experience, existing norms regarding postreferral engagement and oncologist-PCP communication often hinder activation of this role among PCPs. Expected standards regarding the method, frequency, and quality of postreferral communication should be jointly articulated and made accountable between PCPs and oncologists to help improve cancer patients' quality of care, particularly in minority communities. © 2014 American Cancer Society.

Tupikteid ei ole / Aimi Püüa, Kristina Orion, Helen Põllo, Kaie Piiskop

Index Scriptorium Estoniae

2015-01-01

Innove õppekava ja metoodika keskuse juhataja Kaie Piiskop, testide ja uuringute keskuse juht Aimi Püüa, karjääriteenuste üksuse juht Kristina Orion, haridus- ja teadusministeeriumi kutsehariduse osakonna juhataja Helen Põllo arutlesid teemal kuidas jätkata haridusteed

Patterns in Seismicity at Mt St Helens and Mt Unzen

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Lamb, Oliver; De Angelis, Silvio; Lavallee, Yan

2014-05-01

Cyclic behaviour on a range of timescales is a well-documented feature of many dome-forming volcanoes. Previous work on Soufrière Hills volcano (Montserrat) and Volcán de Colima (Mexico) revealed broad-scale similarities in behaviour implying the potential to develop general physical models of sub-surface processes [1]. Using volcano-seismic data from Mt St Helens (USA) and Mt Unzen (Japan) this study explores parallels in long-term behaviour of seismicity at two dome-forming systems. Within the last twenty years both systems underwent extended dome-forming episodes accompanied by large Vulcanian explosions or dome collapses. This study uses a suite of quantitative and analytical techniques which can highlight differences or similarities in volcano seismic behaviour, and compare the behaviour to changes in activity during the eruptive episodes. Seismic events were automatically detected and characterized on a single short-period seismometer station located 1.5km from the 2004-2008 vent at Mt St Helens. A total of 714 826 individual events were identified from continuous recording of seismic data from 22 October 2004 to 28 February 2006 (average 60.2 events per hour) using a short-term/long-term average algorithm. An equivalent count will be produced from seismometer recordings over the later stages of the 1991-1995 eruption at MT Unzen. The event count time-series from Mt St Helens is then analysed using Multi-taper Method and the Short-Term Fourier Transform to explore temporal variations in activity. Preliminary analysis of seismicity from Mt St Helens suggests cyclic behaviour of subannual timescale, similar to that described at Volcán de Colima and Soufrière Hills volcano [1]. Frequency Index and waveform correlation tools will be implemented to analyse changes in the frequency content of the seismicity and to explore their relations to different phases of activity at the volcano. A single station approach is used to gain a fine-scale view of variations in

Oncologists' identification of mental health distress in cancer patients: Strategies and barriers.

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Granek, L; Nakash, O; Ariad, S; Shapira, S; Ben-David, M

2018-03-06

The purpose of this research was to examine oncologists' perspectives on indicators of mental health distress in patients: what strategies they use to identify these indicators, and what barriers they face in this task. Twenty-three oncologists were interviewed, and the grounded theory method of data collection and analysis was used. Oncologists perceived distress to be a normative part of having cancer and looked for affective, physical, verbal and behavioural indicators using a number of strategies. Barriers to identification of mental health distress included difficulty in differentiating between mental health distress and symptoms of the disease, and lack of training. A systematic, time-efficient assessment of symptoms of emotional distress is critical for identification of psychiatric disorders among patients and differentiating normative emotional responses from psychopathology. Clinical bias and misdiagnosis can be a consequence of an ad hoc, intuitive approach to assessment, which can have consequences for patients and their families. Once elevated risk is identified for mental health distress, the patient can be referred to specialised care that can offer evidence-based treatments. © 2018 John Wiley & Sons Ltd.

Global curriculum in research literacy for the surgical oncologist.

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Are, C; Yanala, U; Malhotra, G; Hall, B; Smith, L; Cummings, C; Lecoq, C; Wyld, L; Audisio, R A; Berman, R S

2018-01-01

The ability to provide optimal care to cancer patients depends on awareness of current evidence-based practices emanating from research or involvement in research where circumstances permit. The significant global variations in cancer-related research activity and its correlation to cancer-specific outcomes may have an influence on the care provided to cancer patients and their outcomes. The aim of this project is to develop a global curriculum in research literacy for the surgical oncologist. The leadership of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in research literacy for the Surgical Oncologist. A global curriculum in research literacy is developed to incorporate the required domains considered to be essential to interpret the published research or become involved in research activity where circumstances permit. The purpose of this curriculum is to promote research literacy for the surgical oncologist, wherever they are based. It does not mandate direct research participation which may not be feasible due to restrictions within the local health-care delivery environment, socio-economic priorities and the educational environment of the individual institution where they work. A global curriculum in research literacy is proposed which may promote research literacy or encourage involvement in research activity where circumstances permit. It is hoped that this will enhance cancer-related research activity, promote awareness of optimal evidence-based practices and improve outcomes for cancer patients globally. Copyright © 2017 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists.

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Rivera, F; Andres, R; Felip, E; Garcia-Campelo, R; Lianes, P; Llombart, A; Piera, J M; Puente, J; Rodriguez, C A; Vera, R; Virizuela, J A; Martin, M; Garrido, P

2017-04-01

The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.

Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives.

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Koh, Su-Jin; Kim, Shinmi; Kim, JinShil; Keam, Bhumsuk; Heo, Dae Seog; Lee, Kyung Hee; Kim, Bong-Seog; Kim, Jee Hyun; Chang, Hye Jung; Baek, Sun Kyung

2018-04-01

The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of "terminal state," and mostrespondents tried to disclose the patient's condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

VP Structure of Mount St. Helens, Washington, USA, imaged with local earthquake tomography

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Waite, G.P.; Moran, S.C.

2009-01-01

We present a new P-wave velocity model for Mount St. Helens using local earthquake data recorded by the Pacific Northwest Seismograph Stations and Cascades Volcano Observatory since the 18 May 1980 eruption. These data were augmented with records from a dense array of 19 temporary stations deployed during the second half of 2005. Because the distribution of earthquakes in the study area is concentrated beneath the volcano and within two nearly linear trends, we used a graded inversion scheme to compute a coarse-grid model that focused on the regional structure, followed by a fine-grid inversion to improve spatial resolution directly beneath the volcanic edifice. The coarse-grid model results are largely consistent with earlier geophysical studies of the area; we find high-velocity anomalies NW and NE of the edifice that correspond with igneous intrusions and a prominent low-velocity zone NNW of the edifice that corresponds with the linear zone of high seismicity known as the St. Helens Seismic Zone. This low-velocity zone may continue past Mount St. Helens to the south at depths below 5??km. Directly beneath the edifice, the fine-grid model images a low-velocity zone between about 2 and 3.5??km below sea level that may correspond to a shallow magma storage zone. And although the model resolution is poor below about 6??km, we found low velocities that correspond with the aseismic zone between about 5.5 and 8??km that has previously been modeled as the location of a large magma storage volume. ?? 2009 Elsevier B.V.

Chaos theory: A fascinating concept for oncologists

International Nuclear Information System (INIS)

Denis, F.; Letellier, C.

2012-01-01

The oncologist is confronted daily by questions related to the fact that any patient presents a specific evolution for his cancer: he is challenged by very different, unexpected and often unpredictable outcomes, in some of his patients. The mathematical approach used today to describe this evolution has recourse to statistics and probability laws: such an approach does not ultimately apply to one particular patient, but to a given more or less heterogeneous population. This approach therefore poorly characterizes the dynamics of this disease and does not allow to state whether a patient is cured, to predict if he will relapse and when this could occur, and in what form, nor to predict the response to treatment and, in particular, to radiation therapy. Chaos theory, not well known by oncologists, could allow a better understanding of these issues. Developed to investigate complex systems producing behaviours that cannot be predicted due to a great sensitivity to initial conditions, chaos theory is rich of suitable concepts for a new approach of cancer dynamics. This article is three-fold: to provide a brief introduction to chaos theory, to clarify the main connecting points between chaos and carcinogenesis and to point out few promising research perspectives, especially in radiotherapy. (authors)

Awareness and behavior of oncologists and support measures in medical institutions related to ongoing employment of cancer patients in Japan.

Science.gov (United States)

Wada, Koji; Ohtsu, Mayumi; Aizawa, Yoshiharu; Tanaka, Hiroshi; Tagaya, Nobumi; Takahashi, Miyako

2012-04-01

Improved outcomes of cancer treatment allow patients to undergo treatment while working. However, support from oncologists and medical institutions is essential for patients to continue working. This study aimed to clarify oncologists' awareness and behavior regarding patients who work during treatment, support in medical institutions and their association. A questionnaire was mailed to all 453 diplomates and faculty of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology and all 1016 surgeons certified by the Japanese Board of Cancer Therapy living in the Kanto area. The questionnaire assessed demographics, oncologist awareness and behavior regarding patient employment and support measures at their medical institutions. Logistic regression analysis was used to examine the association of awareness and behavior of oncologists with support measures at their institutions. A total of 668 individuals participated. The overall response rate was 45.5%. Only 53.6% of respondents advised patients to tell their supervisors about prospects for treatment and ask for understanding. For medical institutions, 28.8% had a nurse-involved counseling program and adjustments in radiation therapy (28.0%) and chemotherapy (41.9%) schedules to accommodate patients' work. There was a significant correlation between awareness and behavior of oncologists and medical institutions' measures to support employed cancer patients. There is room for improvement in awareness and behavior of oncologists and support in medical institutions for cancer patients continuing to work. Oncologists could support working patients by exerting influence on their medical institutions. Conversely, proactive development of support measures by medical institutions could alter the awareness and behavior of oncologists.

Awareness and behavior of oncologists and support measures in medical institutions related to ongoing employment of cancer patients in Japan

International Nuclear Information System (INIS)

Wada, Koji; Aizawa, Yoshiharu; Ohtsu, Mayumi; Tanaka, Hiroshi; Tagaya, Nobumi; Takahashi, Miyako

2012-01-01

Improved outcomes of cancer treatment allow patients to undergo treatment while working. However, support from oncologists and medical institutions is essential for patients to continue working. This study aimed to clarify oncologists' awareness and behavior regarding patients who work during treatment, support in medical institutions and their association. A questionnaire was mailed to all 453 diplomates and faculty of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology and all 1016 surgeons certified by the Japanese Board of Cancer Therapy living in the Kanto area. The questionnaire assessed demographics, oncologist awareness and behavior regarding patient employment and support measures at their medical institutions. Logistic regression analysis was used to examine the association of awareness and behavior of oncologists with support measures at their institutions. A total of 668 individuals participated. The overall response rate was 45.5%. Only 53.6% of respondents advised patients to tell their supervisors about prospects for treatment and ask for understanding. For medical institutions, 28.8% had a nurse-involved counseling program and adjustments in radiation therapy (28.0%) and chemotherapy (41.9%) schedules to accommodate patients' work. There was a significant correlation between awareness and behavior of oncologists and medical institutions' measures to support employed cancer patients. There is room for improvement in awareness and behavior of oncologists and support in medical institutions for cancer patients continuing to work. Oncologists could support working patients by exerting influence on their medical institutions. Conversely, proactive development of support measures by medical institutions could alter the awareness and behavior of oncologists. (author)

Environmental Impact of the Helen, Research, and Chicago Mercury Mines on Water, Sediment, and Biota in the Upper Dry Creek Watershed, Lake County, California

Science.gov (United States)

Rytuba, James J.; Hothem, Roger L.; May, Jason T.; Kim, Christopher S.; Lawler, David; Goldstein, Daniel; Brussee, Brianne E.

2009-01-01

The Helen, Research, and Chicago mercury (Hg) deposits are among the youngest Hg deposits in the Coast Range Hg mineral belt and are located in the southwestern part of the Clear Lake volcanic field in Lake County, California. The mine workings and tailings are located in the headwaters of Dry Creek. The Helen Hg mine is the largest mine in the watershed having produced about 7,600 flasks of Hg. The Chicago and Research Hg mines produced only a small amount of Hg, less than 30 flasks. Waste rock and tailings have eroded from the mines, and mine drainage from the Helen and Research mines contributes Hg-enriched mine wastes to the headwaters of Dry Creek and contaminate the creek further downstream. The mines are located on federal land managed by the U.S. Bureau of Land Management (USBLM). The USBLM requested that the U.S. Geological Survey (USGS) measure and characterize Hg and geochemical constituents in tailings, sediment, water, and biota at the Helen, Research, and Chicago mines and in Dry Creek. This report is made in response to the USBLM request to conduct a Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA - Removal Site Investigation (RSI). The RSI applies to removal of Hg-contaminated mine waste from the Helen, Research, and Chicago mines as a means of reducing Hg transport to Dry Creek. This report summarizes data obtained from field sampling of mine tailings, waste rock, sediment, and water at the Helen, Research, and Chicago mines on April 19, 2001, during a storm event. Further sampling of water, sediment, and biota at the Helen mine area and the upper part of Dry Creek was completed on July 15, 2003, during low-flow conditions. Our results permit a preliminary assessment of the mining sources of Hg and associated chemical constituents that could elevate levels of monomethyl Hg (MMeHg) in the water, sediment, and biota that are impacted by historic mining.

A mixed methods analysis of experiences and expectations among early-career medical oncologists in Australia.

Science.gov (United States)

Wong, W K Tim; Kirby, Emma; Broom, Alex; Sibbritt, David; Francis, Kay; Karapetis, Christos S; Karikios, Deme; Harrup, Rosemary; Lwin, Zarnie

2018-01-26

A viable and sustainable medical oncology profession is integral for meeting the increasing demand for quality cancer care. The aim of this study was to explore the workforce-related experiences, perceptions and career expectations of early-career medical oncologists in Australia. A mixed-methods design, including a survey (n  =  170) and nested qualitative semistructured interviews (n  =  14) with early-career medical oncologists. Recruitment was through the Medical Oncology Group of Australia. Qualitative data were thematically analyzed and for the survey results, logistic regression modeling was conducted. Early-career medical oncologists experienced uncertainty regarding their future employment opportunities. The competitive job market has made them cautious about securing a preferred job leading to a perceived need to improve their qualifications through higher degree training and research activities. The following themes and trends were identified from the qualitative and quantitative analyses: age, career stage and associated early-career uncertainty; locale, professional competition and training preferences; participation in research and evolving professional expectations; and workload and career development opportunities as linked to career uncertainty. Perceived diminished employment opportunities in the medical oncology profession, and shifting expectations to be "more qualified," have increased uncertainty among junior medical oncologists in terms of their future career prospects. Structural factors relating to adequate funding of medical oncology positions may facilitate or inhibit progressive change in the workforce and its sustainability. Workforce planning and strategies informed by findings from this study will be necessary in ensuring that both the needs of cancer patients and of medical oncologists are met. © 2018 John Wiley & Sons Australia, Ltd.

Contemporary management of stage i testicular seminoma: a survey of Canadian radiation oncologists

Science.gov (United States)

Samant, R.; Alomary, I.; Genest, P.; Eapen, L.

2008-01-01

Recently published studies clearly indicate that there are now several acceptable options for managing stage i testicular seminoma patients after orchiectomy. We therefore decided to survey Canadian radiation oncologists to determine how they currently manage such patients and to compare the results with previous surveys. Our results demonstrate that adjuvant single-agent chemotherapy is being considered as an option by an increasing proportion of radiation oncologists (although it is not considered the preferred option), the routine use of radiotherapy is declining, and surveillance is becoming increasingly popular and is recommended most often. PMID:18769613

Stress, satisfaction and burnout amongst Australian and New Zealand radiation oncologists.

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Leung, John; Rioseco, Pilar; Munro, Philip

2015-02-01

The aim of this study was to determine the self-reported prevalence of stress, job satisfaction and burnout among radiation oncologists in Australia and New Zealand. A secondary aim was to determine the association between stress and satisfaction parameters with burnout. An anonymous online survey was distributed to all radiation oncologists listed on Royal Australian and New Zealand College of Radiologists membership database. There were 37 Likert scale questions on stress, 17 Likert scale questions on job satisfaction and burnout assessed by the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A principal component analysis was done for stress and satisfaction to identify specific areas. Independent samples t-tests and analysis of variances were done. There were 220 responses out of 348 eligible respondents (63.2% response rate).For stress, a principal component analysis identified five areas: delivery demands, demands on time, continuing professional development (CPD), value and security, and interpersonal/teaching demands. Specialist radiation oncologists were more stressed by value and security than generalists (P stress associated with delivery demands, demands on time and CPD compared with others (P = 0.01). Those over 60 years were less stressed by delivery demands (P = 0.02), demands on time (P = 0.01) and CPD (P = 0.01) than their younger colleagues. Four satisfaction factors were identified in the principal component analysis: resources/remuneration, status/security, delivery of services and professional activities. [Correction added on 15 August 2014, after first online publication: stress/security was replaced with status/security.] Males and Australian radiation oncologists were more satisfied with professional activities (P = 0.02). Brachytherapy specialists were more satisfied with status/security (P = 0.01) while those interested in urology were more satisfied with resources/renumeration (P = 0.01) and

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

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Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Bosch, Walter [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Haas, Rick L.M. [Department of Radiotherapy, Netherlands Cancer Institute, 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); Olsen, Jeffrey R. [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Deville, Curtiland [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Chen, Yen-Lin [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Finkelstein, Steven E. [Translational Research Consortium, 21st Century Oncology, Scottsdale, Arizona (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States)

2015-08-01

Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

International Nuclear Information System (INIS)

Baldini, Elizabeth H.; Abrams, Ross A.; Bosch, Walter; Roberge, David; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Olsen, Jeffrey R.; Deville, Curtiland; Chen, Yen-Lin; Finkelstein, Steven E.; DeLaney, Thomas F.; Wang, Dian

2015-01-01

Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed

Patient-oncologist cost communication, financial distress, and medication adherence.

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Bestvina, Christine M; Zullig, Leah L; Rushing, Christel; Chino, Fumiko; Samsa, Gregory P; Altomare, Ivy; Tulsky, James; Ubel, Peter; Schrag, Deborah; Nicolla, Jon; Abernethy, Amy P; Peppercorn, Jeffrey; Zafar, S Yousuf

2014-05-01

Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions. Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions. Copyright © 2014 by American Society of Clinical Oncology.

Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer.

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Trevino, Kelly M; Abbott, Caroline H; Fisch, Michael J; Friedlander, Robert J; Duberstein, Paul R; Prigerson, Holly G

2014-08-01

Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient-oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. A total of 93 young adult patients (aged 20 years-40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two-thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance. Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions. The patient-oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients. �

What advice are oncologists and surgeons in the United Kingdom giving to breast cancer patients about physical activity?

Directory of Open Access Journals (Sweden)

Daley Amanda J

2008-09-01

Full Text Available Abstract Evidence has shown that physical activity may attenuate the negative physical, psychological and functional effects of treatment in women diagnosed with breast cancer. Physical activity levels also decline substantially during and after completion of treatment for cancer, highlighting the importance of strategies to promote participation in regular physical activity in this population. Oncologists and surgeons may serve as an influential source of motivation to be physically activity in cancer patients, by conveying the importance of a healthy lifestyle. The primary purpose of the present study was to investigate whether oncologists and surgeons routinely discuss physical activity with their breast cancer patients and to investigate the nature of any information/advice provided during consultations. A secondary aim was to examine whether physically active oncologists and surgeons were more likely to provide advice about physical activity to patients, than inactive oncologists and surgeons. A brief postal questionnaire was sent to 710 consultant breast cancer oncologists and surgeons throughout the UK and 102 responded (response rate = 14.4%. Of responders, most (55.9% did not routinely discuss physical activity with their patients. Amongst oncologists/surgeons (clinicians who did offer advice, most focussed on discussing the benefits of physical activity for physical and functional health gains and for facilitating weight control and maintenance. A number of clinicians indicated they advised patients that physical activity may decrease risk of recurrence and improve survival, despite the lack of evidence from RCTs to support this suggestion. There was no significant association between the physical activity status of oncologists/surgeons and the likelihood that they discussed physical activity with patients. Educational strategies aimed at encouraging clinicians to promote physical activity in consultations need to be targeted widely

Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists.

Science.gov (United States)

Shin, Dong Wook; Cho, Juhee; Roter, Debra L; Kim, So Young; Yang, Hyung Kook; Park, Keeho; Kim, Hyung Jin; Shin, Hee-Young; Kwon, Tae Gyun; Park, Jong Hyock

2017-06-01

To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ. A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator-developed questionnaire regarding family involvement in cancer TDM. Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P family decisional control than caregivers (P family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision. Copyright © 2016 John Wiley & Sons, Ltd.

Helen Howitt: una semilla canadiense en la enfermería latinoamericana

Directory of Open Access Journals (Sweden)

ANA LUISA VELANDIA MORA

2009-07-01

Full Text Available Este trabajo se propone hacer visible la presencia de Helen Howitt en la enfermería latinoamericana. Paralelamente pretende hacer un análisis de la influencia política del Servicio Cooperativo Interamericano de Salud Pública en la enfermería de la región y la presencia de organizaciones religiosas, especialmente norteamericanas, en varios países latinoamericanos. Helen Howitt, enfermera canadiense egresada de la Universidad de Alberta, fue enviada en 1942 por la Organización Panamericana de la Salud, OPS para que asesorara en Colombia al Ministerio de Trabajo, Higiene y Previsión Social. Pasó a formar parte del proyecto de apertura y organización de la Escuela Nacional Superior de Enfermeras, y fue su primera directora. Helen Howitt fue directora de la Escuela de Enfermería del Hospital Santo Tomás de la Zona del Canal de Panamá entre 1933 y 1938, luego fundadora y primera directora de la Escuela Nacional Superior de Enfermeras de Colombia entre los años 1943 y 1951; posteriormente de la Escuela Nacional de Enfermeras de Bolivia entre 1953 y 1959, cuando fue invitada a cumplir un cargo similar en Venezuela. A todos estos países llegó primero como consultora del respectivo Ministerio de Salud, a través de convenios con el Servicio Cooperativo Interamericano de Salud Pública. La Fundación Rockefeller daba becas para todos los países latinos. En la Escuela del Hospital Santo Tomás de Panamá había estudiantes de toda la América Central, Venezuela, Colombia, hasta del Ecuador y la Argentina. La Rockefeller quería unificar la enfermería en toda Latinoamérica. Llegó primero a Venezuela; y las enfermeras que se graduaron en Panamá fueron las líderes en América Latina, donde trataron de fundar escuelas.

Oncologists' non-verbal behavior and analog patients' recall of information

NARCIS (Netherlands)

Hillen, Marij A.; de Haes, Hanneke C. J. M.; van Tienhoven, Geertjan; van Laarhoven, Hanneke W. M.; van Weert, Julia C. M.; Vermeulen, Daniëlle M.; Smets, Ellen M. A.

2016-01-01

Background Information in oncological consultations is often excessive. Those patients who better recall information are more satisfied, less anxious and more adherent. Optimal recall may be enhanced by the oncologist's non-verbal communication. We tested the influence of three non-verbal behaviors,

Digestive oncologist in the gastroenterology training curriculum

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Mulder, Chris Jacob Johan; Peeters, Marc; Cats, Annemieke; Dahele, Anna; Droste, Jochim Terhaar sive

2011-01-01

Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum end-points in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce well-trained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal of these programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum. PMID:21556128

[Chaos theory: a fascinating concept for oncologists].

Science.gov (United States)

Denis, F; Letellier, C

2012-05-01

The oncologist is confronted daily by questions related to the fact that any patient presents a specific evolution for his cancer: he is challenged by very different, unexpected and often unpredictable outcomes, in some of his patients. The mathematical approach used today to describe this evolution has recourse to statistics and probability laws: such an approach does not ultimately apply to one particular patient, but to a given more or less heterogeneous population. This approach therefore poorly characterizes the dynamics of this disease and does not allow to state whether a patient is cured, to predict if he will relapse and when this could occur, and in what form, nor to predict the response to treatment and, in particular, to radiation therapy. Chaos theory, not well known by oncologists, could allow a better understanding of these issues. Developed to investigate complex systems producing behaviours that cannot be predicted due to a great sensitivity to initial conditions, chaos theory is rich of suitable concepts for a new approach of cancer dynamics. This article is three-fold: to provide a brief introduction to chaos theory, to clarify the main connecting points between chaos and carcinogenesis and to point out few promising research perspectives, especially in radiotherapy. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Nature of Medical Malpractice Claims Against Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

Marshall, Deborah; Tringale, Kathryn [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Connor, Michael [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); University of California Irvine School of Medicine, Irvine, California (United States); Punglia, Rinaa [Department of Radiation Oncology, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (United States); Hattangadi-Gluth, Jona, E-mail: jhattangadi@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

2017-05-01

Purpose: To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Methods and Materials: Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. Results: There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included “improper performance” (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), “errors in diagnosis” (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and “no medical misadventure” (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. “Improper performance” was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment. Conclusions: Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against

A medical oncologist's perspective on communication skills and burnout syndrome with psycho-oncological approach (to die with each patient one more time: the fate of the oncologists).

Science.gov (United States)

Tanriverdi, Ozgur

2013-06-01

The increasing incidence of cancer is at the same time one of the leading causes of death all over the world. Many clinical studies show that the psychological disorders are more frequent in cancer patients than the normal population. That is the reason why "psycho-oncology" is getting popular each day. On the other hand, clinical studies about psychological status of the oncologists who are in contact with cancer patients ceaselessly and who are mostly responsible to give the "bad news" to the cancer patients are very limited. In fact, if the clinical studies which show that the frequency of depression and burnout syndrome are increasing among physicians are taken into consideration, one can say that psycho-oncology must cover all the medical personnel who are dealing with cancer patients. It is determined that the rate of depression and burnout syndrome is high among oncologists when referred to the literature. Several solutions are proposed for the psychological conditions of the oncologists and other related personnel who empathize with the patients and deliver "bad news" and also try to adopt ideal "patient-physician" communication model. The knowledge on the psychological conditions of oncology professionals and their behaviour and the results of the clinical studies on this subject will be discussed and the personal opinion will also be presented in this paper.

Future Supply and Demand for Oncologists : Challenges to Assuring Access to Oncology Services

Science.gov (United States)

Erikson, Clese; Salsberg, Edward; Forte, Gaetano; Bruinooge, Suanna; Goldstein, Michael

2007-01-01

Purpose To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO. Methods New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000–2002) of age- and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models. Results Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists—roughly one-quarter to one-third of the 2005 supply. The baseline projections do not

Helene: A Plastic Model

Science.gov (United States)

Umurhan, O. M.; Moore, J. M.; Howard, A. D.; Schenk, P.; White, O. L.

2014-12-01

Helene, the Saturnian L4 Trojan satellite co-orbiting Dionne and sitting within the E-ring, possesses an unusual morphology characteristic of broad km-scale basins and depressions and a generally smooth surface patterned with streaks and grooves which are indicative of non-typical mass transport. Elevation angles do not appear to exceed 10o at most. The nature and origin of the surface materials forming these grooved patterns is unknown. Given the low surface gravity (plastic-like flow like a Bingham fluid, we setup and test a number of likely scenarios to explain the observations. The numerical results qualitatively indicate that treating the mass-wasting materials as a Bingham material reproduces many of the qualitative features observed. We also find that in those simulations in which accretion is concomitant with Bingham mass-wasting, the long time-evolution of the surface flow shows intermittency in the total surface activity (defined as total surface integral of the absolute magnitude of the mass-flux). Detailed analyses identify the locations where this activity is most pronounced and we will discuss these and its implications in further detail.

Zwischen Aufbegehren und bürgerlicher Rolle: die Lebensgemeinschaft von Helene Lange und Gertrud Bäumer The partnership of Helene Lange und Gertrud Bäumer: a both rebellious and domestic way of life

Directory of Open Access Journals (Sweden)

Mechthilde Vahsen

2001-07-01

Full Text Available Die Forschungsarbeiten analysieren private weibliche Beziehungsformen und ihre Bedeutung für die erste deutsche Frauenbewegung. Im Zentrum der Betrachtung steht eines der wichtigsten Führungspaare dieser Zeit: Helene Lange und Gertrud Bäumer. Die Dissertation von Göttert liefert einen wichtigen Beitrag zur Netzwerkforschung, Schaser beschäftigt sich in ihrer innovativen Studie mit der Lebensgemeinschaft der beiden Frauen, die sie in die frauenbewegten und politischen Kontexte einordnet.These studies analyse the private aspects of female relationship and their significance for the first wave of the German women’s movement. The focus is on the leading couple at that particular time: Helene Lange and Gertrud Bäumer. The dissertation by Göttert contributes an important piece to the network research, whereas Schaser describes in her innovative study the partnership of the two women, which is strongly related to the feminist and political context.

The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: A decision analysis.

Science.gov (United States)

Turner, Taylor B; Dilley, Sarah E; Smith, Haller J; Huh, Warner K; Modesitt, Susan C; Rose, Stephen L; Rice, Laurel W; Fowler, Jeffrey M; Straughn, J Michael

2017-09-01

Physician burnout is associated with mental illness, alcohol abuse, and job dissatisfaction. Our objective was to estimate the impact of burnout on productivity of gynecologic oncologists during the first half of their career. A decision model evaluated the impact of burnout on total relative value (RVU) production during the first 15years of practice for gynecologic oncologists entering the workforce from 2011 to 2015. The SGO practice survey provided physician demographics and mean annual RVUs. Published data were used to estimate probability of burnout for male and female gynecologic oncologists, and the impact of depression, alcohol abuse, and early retirement. Academic productivity was defined as annual PubMed publications since finishing fellowship. Without burnout, RVU production for the cohort of 250 gynecologic oncologists was 26.2 million (M) RVUs over 15years. With burnout, RVU production decreased by 1.6 M (5.9% decrease). Disproportionate rates of burnout among females resulted in 1.1 M lost RVUs for females vs. 488 K for males. Academic production without burnout was estimated at 9277 publications for the cohort. Burnout resulted in 1383 estimated fewer publications over 15years (14.9%). The impact of burnout on clinical and academic productivity is substantial across all specialties. As health care systems struggle with human resource shortages, this study highlights the need for effective burnout prevention and wellness programs for gynecologic oncologists. Unless significant resources are designated to wellness programs, burnout will increasingly affect the care of our patients and the advancement of our field. Copyright © 2017 Elsevier Inc. All rights reserved.

National survey on prophylactic cranial irradiation: differences in practice patterns between medical and radiation oncologists

International Nuclear Information System (INIS)

Cmelak, Anthony J.; Choy, Hak; Shyr, Yu; Mohr, Peter; Glantz, Michael J.; Johnson, David H.

1999-01-01

Purpose: Prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) patients remains controversial in the oncology community because of its potential for long-term toxicity and unproven survival benefit in randomized trials. A national survey of 9176 oncologists was conducted to characterize the use of PCI with regard to physician demographics, patient characteristics, and oncologists' beliefs. Methods: Data was collected via a questionnaire letter survey. Biographical data, treatment patterns, and clinical impressions were analyzed by the generalized linear model and generalized estimating equations method. Results: There were 1231 responders overall (13.4% of those surveyed), including 628 (51%) radiation oncologists (RO), 587 (48%) medical oncologists (MO), 8 (0.6%) surgical oncologists, and 8 (0.6%) from other oncology subspecialties. Of respondents, 74% overall recommend PCI in limited-stage patients, including 65% of MO and 82% RO (p = 0.001). Of responders who recommend PCI in limited-stage patients, 67% do so only after complete response to initial therapy. Only 30% of respondents recommend PCI for extensive-stage SCLC patients (p = 0.001), and 94% of these recommend PCI only when those patients have a complete response after initial therapy. Interestingly, 38% of responding MO feel that PCI improves survival of limited-stage patients, but only 11% believe PCI improves quality of life. Of the RO, 48% believe PCI improves survival in limited-stage SCLC, and 36% feel PCI improves quality of life (p < 0.05 and p < 0.01, respectively). MO responders believe PCI causes late neurological sequelae more often than do RO responders (95% vs. 84%, p < 0.05), with impaired memory (37%), chronic fatigue (19%), and loss of motivation (13%) as most commonly seen side effects. Only 1.5% overall, however, routinely obtain neuropsychiatric testing in PCI patients, and 42% overall never obtain them. Conclusion: Results confirm that oncologic

[Comparison of set-up control for head and neck patients between radiation oncologist and therapists with the aim of partial delegation].

Science.gov (United States)

Garcia-Ramirez, M; Maugey, S; Burgaud, L; Carpentey, F; Parezys, E; Carricaburu, M

2014-11-01

The aim of this prospective study was to evaluate daily set-up by a radiation oncologist and by radiation therapists using on-board imaging of patients with head and neck cancer in order to calculate margin to PTV (planning target volume) and intent partial delegation of positioning images control. The files of 11 patients with head and neck cancer treated on a Synergy™ (Elekta™) accelerator with on-board imaging system were evaluated. Daily kV-kV images were double-blind reviewed by radiation therapists (7 participants) and by one radiation oncologist. The radiation oncologist's measures were used for margin calculation from CTV to PTV. The difference of measures and the concordance of decisions between radiation therapists and the radiation oncologist were calculated. The 325 measures made by the radiation oncologist resulted in a margin of 5mm to be applied to the CTV in each direction. Nine hundred seventy-seven measures were made by the radiation oncologist and radiation therapists with a difference of 3mm or less in 98.46%. The concordance of decision for a 4mm difference or less to the isocenter was 96.7%. This study confirms the 5mm PTV margin mostly used in ORL. The small gap between the radiation oncologist's and therapists' measures allows a partial delegation of positioning images control. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States.

Science.gov (United States)

Mowery, Yvonne M; Salama, Joseph K; Zafar, S Yousuf; Moore, Harvey G; Willett, Christopher G; Czito, Brian G; Hopkins, M Benjamin; Palta, Manisha

2017-04-15

Short-course radiotherapy (SC-RT) and long-course chemoradiotherapy (LC-CRT) are accepted neoadjuvant treatments of rectal cancer. In the current study, the authors surveyed US radiation oncologists to assess practice patterns and attitudes regarding SC-RT and LC-CRT for patients with rectal cancer. The authors distributed a survey to 1701 radiation oncologists regarding treatment of neoadjuvant rectal cancer. Respondents were asked questions regarding the number of patients with rectal cancer treated, preference for SC-RT versus LC-CRT, and factors influencing regimen choice. Of 1659 contactable physicians, 182 responses (11%) were received. Approximately 83% treated at least 5 patients with rectal cancer annually. The majority of responding radiation oncologists (96%) preferred neoadjuvant LC-CRT for the treatment of patients with locally advanced rectal cancer and 44% never used SC-RT. Among radiation oncologists using SC-RT, respondents indicated they would not recommend this regimen for patients with low (74%) or bulky tumors (70%) and/or concern for a positive circumferential surgical resection margin (69%). The most frequent reasons for not offering SC-RT were insufficient downstaging for sphincter preservation (53%) and a desire for longer follow-up (45%). Many radiation oncologists indicated they would prescribe SC-RT for patients not receiving chemotherapy (62%) or patients with a geographic barrier to receiving LC-CRT (82%). Patient comorbidities appeared to influence regimen preferences for 79% of respondents. Approximately 20% of respondents indicated that altered oncology care reimbursement using capitated payment by diagnosis would impact their consideration of SC-RT. US radiation oncologists rarely use neoadjuvant SC-RT despite 3 randomized controlled trials demonstrating no significant differences in outcome compared with LC-CRT. Further research is necessary to determine whether longer follow-up coupled with the benefits of lower cost, increased

Zircon reveals protracted magma storage and recycling beneath Mount St. Helens

Science.gov (United States)

Claiborne, L.L.; Miller, C.F.; Flanagan, D.M.; Clynne, M.A.; Wooden, J.L.

2010-01-01

Current data and models for Mount St. Helens volcano (Washington, United States) suggest relatively rapid transport from magma genesis to eruption, with no evidence for protracted storage or recycling of magmas. However, we show here that complex zircon age populations extending back hundreds of thousands of years from eruption age indicate that magmas regularly stall in the crust, cool and crystallize beneath the volcano, and are then rejuvenated and incorporated by hotter, young magmas on their way to the surface. Estimated dissolution times suggest that entrained zircon generally resided in rejuvenating magmas for no more than about a century. Zircon elemental compositions reflect the increasing influence of mafic input into the system through time, recording growth from hotter, less evolved magmas tens of thousands of years prior to the appearance of mafic magmas at the surface, or changes in whole-rock geochemistry and petrology, and providing a new, time-correlated record of this evolution independent of the eruption history. Zircon data thus reveal the history of the hidden, long-lived intrusive portion of the Mount St. Helens system, where melt and crystals are stored for as long as hundreds of thousands of years and interact with fresh influxes of magmas that traverse the intrusive reservoir before erupting. ?? 2010 Geological Society of America.

Satisfaction with work-life balance among U.S. gynecologic oncologists, a cross-sectional study.

Science.gov (United States)

Szender, J Brian; Grzankowski, Kassondra S; Eng, Kevin H; Lele, Shashikant B; Odunsi, Kunle; Frederick, Peter J

To evaluate the satisfaction with work-life balance (WLB) and career satisfaction of gynecologic oncologists. In August 2014, members of the Society of Gynecologic Oncology (SGO) were sent an anonymous, cross-sectional survey evaluating demographic variables, practice characteristics, career satisfaction, fatigue, and satisfaction with WLB. Fatigue was assessed using a visual-analog scale. Career satisfaction and WLB were assessed with a Likert scale. Inferential statistics were computed with type I error rates of 0.05. Out of the 1002 gynecologic oncologists surveyed, 290 (28.9%) responded. Only 18.6% of respondents were satisfied with WLB and there were significant associations between gender (P = 0.0157), time spent in work related activities at home (P = 0.0024), on weekends (P = 0.0017), and in the hospital (P = 0.0001). More than 84% of physicians reported they would choose medicine as a career again and of those 90% would choose to be a gynecologic oncologist again. Fatigue was strongly associated with dissatisfaction with WLB in univariate and multivariate analysis (P satisfaction may assist the SGO in meeting future gynecologic cancer care needs.

Leonardo da Vinci jõudis Tallinna / Orest Kormašov, Helen Kokk ; intervjueerinud Ants Juske

Index Scriptorium Estoniae

Kormašov, Orest, 1964-

2010-01-01

Kadrioru Kunstimuuseumis eksponeeritakse 5.-12. veebruarini 2010. a. Leonardo da Vinci arvatavat autoportreed. Itaalia kunstiajaloolased kaasasid autoportree uurimisse Tallinna Ülikooli maaliosakonna juhataja Orest Kormašovi, kes teostas klassikalise portreeskulptuuri, ja Eesti Kunstiakadeemia graafilise disaini tudengi Helen Koka, kes valmistas arvutiimitatsiooni

Effects on the Mount St. Helens volcanic cloud on turbidity at Ann Arbor, Michigan

International Nuclear Information System (INIS)

Ryznar, E.; Weber, M.R.; Hallaron, T.S.

1981-01-01

Measurements of turbidity were made at the University of Michigan irradiance and metorlogical measurement facility just prior to, during and after the passage of the volcanic cloud from the 18 May 1980 eruption of Mount St. Helens. They were made with a Volz sunphotometer at wavelengths of 500 and 880 nm

Kuidas toetate sel õppeaastal oma valla koolilapsi? / Külle Viks, Helen Metsma, Aivar Surva...[jt.

Index Scriptorium Estoniae

2009-01-01

Küsimusele vastavad: Türi vallavalitsuse haridusspetsialist Külle Viks, Sõmerpalu valla lastekaitse ja sotsiaaltoetuste spetsialist Helen Metsma, Mäetaguse vallavanem Aivar Surva, Rapla abivallavanem Imbi Kalberg, Kärdla linna haridusnõunik Juta Alev, Albu vallavalitsuse sotsiaalnõunik Claire Miljukova, Võru linnavalitsuse haridusspetsialist Kristi Aavakivi

Survey of Medical Oncology Status in Korea (SOMOS-K): A National Survey of Medical Oncologists in the Korean Association for Clinical Oncology (KACO).

Science.gov (United States)

Kim, Do Yeun; Lee, Yun Gyoo; Kim, Bong-Seog

2017-07-01

This study was conducted to investigate the current role of medical oncologists in cancer care with a focus on increasing the recognition of medical oncology as an independent specialty. Questionnaires modified from the Medical Oncology Status in Europe Survey dealing with oncology structure, resources, research, and patterns of care given by medical oncologists were selected. Several modifications were made to the questionnaire after feedback from the insurance and policy committee of the Korean Association for Clinical Oncology (KACO). The online survey was then sent to KACO members. A total of 214 medical oncologists (45.8% of the total inquiries), including 71 directors of medical oncology institutions, took the survey. Most institutions had various resources, including a medical oncology department (94.1%) and a department of radiation oncology (82.4%). There was an average of four medical oncologists at each institution. Medical oncologists were involved in various treatments from diagnosis to end-of-life care. They were also chemotherapy providers from a wide range of institutions that treated many types of solid cancers. In addition, 86.2% of the institutions conducted research. This is the first national survey in Korea to show that medical oncologists are involved in a wide range of cancer treatments and care. This survey emphasizes the contributions and proper roles of medical oncologists in the evolving health care environment in Korea.

Rhetoric, Possibility, and Women's Status in Ancient Athens: Gorgias' and Isocrates' Encomiums of Helen.

Science.gov (United States)

Biesecker, Susan L.

1992-01-01

Critiques teleological narrative structures implicit in the work of some classical historians, adopting instead a multilayered historiographical method. Argues that a law instituted in 451/450 B.C.E. by Pericles opened up a possibility for resisting women's exclusion from the public sphere. Reads Gorgias' and Isocrates' speeches on Helen of Troy…

Water sampling at the Berge Helene FPSO at Chinguetti field in Mauritania using passive samplers

NARCIS (Netherlands)

Korytar, P.; Galien, van der W.

2007-01-01

Three rounds of water sampling were performed at the Berge Helene FPSO at the Chinguetti field in Mauritania using passive samplers attached to the FPSO to determine the levels of contamination that could potentially accumulate in organisms. Two rounds were carried out prior to the commencement of

Professional Burnout in European Young Oncologists

DEFF Research Database (Denmark)

Banerjee, Sutanuka; Califano, R; Corral, Javier

2017-01-01

≤40 (YOs). Methods: A survey was conducted using the validated Maslach Burnout Inventory (MBI) and additional questions exploring work/lifestyle factors. Statistical analyses were performed to identify factors associated with burnout. Results: 737 surveys (all ages) were collected from 41 European......Background: Burnout in health care professionals could have serious negative consequences on quality of patient care, professional satisfaction and personal life. Our aim was to investigate the burnout prevalence, work and lifestyle factors potentially affecting burnout amongst European oncologists...... = 0.0001 ) and low accomplishment was highest in the 26-30 age group ( p work/life balance, access to support services, living alone and inadequate vacation time remained independent burnout factors ( p 

Impact of poster presentations on academic knowledge transfer from the oncologist perspective in Turkey.

Science.gov (United States)

Arslan, Deniz; Koca, Timur; Tastekin, Didem; Basaran, Hamit; Bozcuk, Hakan

2014-01-01

Currently poster presentations offer a common visual medium for knowledge transfer by a wide range of health professionals. Our study aimed to determine the scientific importance of poster presentations for Medical and Radiation Oncologists. A survey form including 40 questions was distributed to a total of 131 oncologists experienced in poster presentations. One hundred completed survey forms were included in the study. Descriptive statistics and modified thematic analyses were performed on the responses. Overall 64% of the participants agreed that posters were a good medium for knowledge transfer. Some 88% agreed that concise and clear styled presentations would increase appealing interests for poster contents. Visual appearance was cited more influential than content of the subject; 70% of participants agreed that appearances of posters could help to draw more viewer attention. Of respondents, 63% believed that posters accompanied by their author were more attractive for congress attendees, and 33% of them declared that the halo effect of the poster presenter was also important. The present study indicated that intelligibility, appearance and visuality of posters are most important factors from the aspect of oncologist participants. Presenters must take into account these important points when preparing their academic posters.

A Gentle Frost: Poet Helen Frost Talks about the Healing Power of Poetry and Her Latest Novel

Science.gov (United States)

Margolis, Rick

2006-01-01

This article presents an interview with poet Helen Frost. Frost talked about how poetry can help at-risk children. She also related the challenges she faced when she wrote her latest book titled "The Braid."

Resonancias Vocales y Memoria Sonora en Helen Brown

Directory of Open Access Journals (Sweden)

Andrés Grumann Sölter

2016-09-01

Full Text Available El artículo se concentra en indagar aspectos referidos a la intensificación de los usos de la voz y la sonorización musical que proponen Trinidad Piriz y Daniel Marabolí en Helen Brown (2013. Dando cuenta de un marco teórico que cuestiona la dimensión referencial con la que se analiza frecuentemente al teatro y proponiendo una aproximación fenomenológica que dé cuenta de la materialidad performativa que insta a intensificar las resonancias de la voz y la capacidad audible del sonido, el escrito analiza dos escenas o tracks en los que la memoria hecha cuerpo compromete de un modo particular a los espectadores que participan de la performance escénica.

Mount St. Helens: Controlled-source audio-frequency magnetotelluric (CSAMT) data and inversions

Science.gov (United States)

Wynn, Jeff; Pierce, Herbert A.

2015-01-01

This report describes a series of geoelectrical soundings carried out on and near Mount St. Helens volcano, Washington, in 2010–2011. These soundings used a controlled-source audio-frequency magnetotelluric (CSAMT) approach (Zonge and Hughes, 1991; Simpson and Bahr, 2005). We chose CSAMT for logistical reasons: It can be deployed by helicopter, has an effective depth of penetration of as much as 1 kilometer, and requires less wire than a Schlumberger sounding.

Controversies in oncologist-patient communication: a nuanced approach to autonomy, culture, and paternalism.

Science.gov (United States)

Cherny, Nathan I

2012-01-01

Difficult dialogues with patients facing life-changing decisions are an intrinsic part of oncologic practice and a major source of stress. Having a sophisticated approach to the concepts of autonomy, paternalism, and culture can help in addressing difficult dilemmas that arise around the issues of disclosure and decision making. This article addresses some of the most common major challenges in oncologist-patient communication with a nuanced approach to the concepts of autonomy, paternalism, and culture. It introduces the new concept of"voluntary diminished autonomy" and describes the implications this concept has for the consent process. It also attempts to bring clarity to common problems and misconceptions relating to culture, paternalism, and therapeutic privilege as these pertain to the communication practices of oncologists.

Anxiety, Culture, and Expectations: Oncologist-Perceived Factors Associated With Use of Nonrecommended Serum Tumor Marker Tests for Surveillance of Early-Stage Breast Cancer.

Science.gov (United States)

Hahn, Erin E; Munoz-Plaza, Corrine; Wang, Jianjin; Garcia Delgadillo, Jazmine; Schottinger, Joanne E; Mittman, Brian S; Gould, Michael K

2017-01-01

Breast cancer offers several opportunities for reducing use of ineffective practices based on American Society of Clinical Oncology guidelines. We assessed oncologist-perceived factors associated with use of one such practice-serum tumor markers for post-treatment breast cancer surveillance-focusing on medical oncologists with high, medium, or low test use. Using a mixed-methods design, we identified patients who had been treated for early-stage breast cancer diagnosed between January 1, 2009, and December 31, 2012, within Kaiser Permanente Southern California and calculated the number of tests ordered from January 1, 2010, to December 31, 2014. We identified oncologists with high, medium, or low use and subsequently performed semistructured interviews. We used patient satisfaction data to assess association between pattern of use and satisfaction score. We identified 7,363 patients, with 40,114 tests ordered. High-use oncologists were defined as those ordering at least one test annually for 35% of patients or more, low-use oncologists as those ordering at least one test for 5% of patients or less; 42% of oncologists were high, 27% low, and 31% medium users. We interviewed 17 oncologists: six high, eight low, and three medium users. Factors associated with high use included: perceived patient anxiety, oncologist anxiety, belief that there was nothing else to offer, concern about satisfaction, patient competition, peer use, and system barriers. Factors associated with low use included: beliefs about consequences (eg, causes harms) and medical center culture (eg, collective decision to follow guidelines). We found no association between satisfaction score and pattern of use. Barriers to deimplementation are numerous and complex. Traditional strategies of practice change alone are unlikely to be effective. Multifaceted, multilevel strategies deployed to address patient-, clinician-, and system-related barriers may be required.

Petrology of the 2004-2006 Mount St. Helens lava dome -- implications for magmatic plumbing and eruption triggering: Chapter 30 in A volcano rekindled: the renewed eruption of Mount St. Helens, 2004-2006

Science.gov (United States)

Pallister, John S.; Thornber, Carl R.; Cashman, Katharine V.; Clynne, Michael A.; Lowers, Heather; Mandeville, Charles W.; Brownfield, Isabelle K.; Meeker, Gregory P.; Sherrod, David R.; Scott, William E.; Stauffer, Peter H.

2008-01-01

Eighteen years after dome-forming eruptions ended in 1986, and with little warning, Mount St. Helens began to erupt again in October 2004. During the ensuing two years, the volcano extruded more than 80×106 m3 of gas-poor, crystal-rich dacite lava. The 2004-6 dacite is remarkably uniform in bulk-rock composition and, at 65 percent SiO2

Survey of Michigan dentists and radiation oncologists on oral care of patients undergoing head and neck radiation therapy.

Science.gov (United States)

Patel, Yoshita; Bahlhorn, Hannah; Zafar, Saniya; Zwetchkenbaum, Samuel; Eisbruch, Avraham; Murdoch-Kinch, Carol Anne

2012-07-01

Oral complications of radiation therapy for head and neck cancer (HNC) are associated with a significant decline in oral health-related quality of life (OHQOL). The dentist, working with the radiation oncologist and the rest of the health care team, plays an important role in the prevention and management of these complications, but patients do not always receive care consistent with current guidelines. This study investigated barriers to recommended care. There is variability in knowledge and practice among dentists and radiation oncologists regarding the dental management of patients treated with head and neck radiotherapy (HNRT), and inadequate communication and collaboration between members of the patient's health care team contribute to inconsistencies in application of clinical care guidelines. There is on interest and need for continuing dental (CDE) and medical education (CME) on this topic. A questionnaire was developed to assess dentists' knowledge and practice of dental management of HNC patients and their interest in CDE on this topic. All members of the Michigan Dental Association (MDA) with email addresses were asked to complete the survey online, and a random sample of MDA members without email addresses was invited to complete a paper version of the same survey. All Michigan members of the American Society for Radiation Oncology (ASTRO) were invited to complete an online version of the survey modified for radiation oncologists. The response rate for dentists was 47.9% and radiation oncologists was 22.3%. Of the dentists who responded, 81% reported that a major barrier to providing dental treatment before radiotherapy was a lack of time between initial dental consultation and the start of radiation; inadequate communication between health care providers was blamed most frequently for this. Ten percent of the dentists and 25% of the radiation oncologists reported that they did not treat HNC patients because they lacked adequate training, and 55% of

A Qualitative Study of Medical Oncologists' Experiences of Their Profession and Workforce Sustainability.

Directory of Open Access Journals (Sweden)

Alex Broom

Full Text Available Medical oncology is a steadily evolving field of medical practice and professional pathway for doctors, offering value, opportunity and challenge to those who chose this medical specialty. This study examines the experiences of a group of Australian medical oncologists, with an emphasis on their professional practice, career experiences, and existing and emerging challenges across career stages.In-depth qualitative interviews were conducted with 22 medical oncologists, including advanced trainees, early-career consultants and senior consultants, focusing on: professional values and experiences; career prospects and pathways; and, the nexus of the characteristics of the profession and delivery of care.The following themes were emergent from the interviews: the need for professional reinvention and the pressure to perform; the importance, and often absence, of mentoring and feedback loops; the emotional labour of oncology; and, the impact of cascading workload volume on practice sustainability.Understanding professional experiences, career trajectories and challenges at the workforce level are crucial for understanding what drives the oncological care day-to-day. The results indicate that there are considerable potential tensions between the realities of professional, workforce demands and expectations for patient care. Such tensions have real and significant consequences on individual medical oncologists with respect to their futures, aspirations, satisfaction with work, caring practices, interactions with patients and potentially therapeutic outcomes.

The reality of economics for oncologists.

Science.gov (United States)

Taylor, David

2017-06-01

This article outlines the historical development of health economics and its present role in oncology related health technology assessments (HTAs). Despite concerns about the prices and immediate costs of new anticancer medicines for indications such as breast cancer overall spending on such treatments is affordable and offers long term value for money in countries such as the US, Canada and those of Western Europe. Oncologists wishing to protect the interests of current and future patients with both advanced and earlier stage cancers may be regarded as having a responsibility to understand the nature of health economic evaluations, and to be actively involved in decisions affecting access to current treatments and future levels of investment in incrementally improving therapies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perceptions of Radiation Oncologists and Urologists on Sources and Type of Evidence to Inform Prostate Cancer Treatment Decisions

International Nuclear Information System (INIS)

Han, Leona C.; Delpe, Sophia; Shah, Nilay D.; Ziegenfuss, Jeanette Y.; Tilburt, Jon C.; Karnes, R. Jeffrey; Nguyen, Paul L.; Gross, Cary P.; Yu, James B.; Trinh, Quoc-Dien; Sun, Maxine; Ranasinghe, Weranja K.B.; Kim, Simon P.

2014-01-01

Purpose: To perform a national survey of radiation oncologists and urologists about the type of resources used and the level of evidence needed to change clinical practice in localized prostate cancer. Methods and Materials: From a random sample, 1422 physicians were mailed a survey assessing the types of information used and what level of evidence could alter their clinical practice in prostate cancer. Multivariable logistic regression models were used to identify differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs 46%; P=.46). Specialty-specific journals represented the most commonly used resource for informing the clinical practice for radiation oncologists (65%) and urologists (70%). Relative to radiation oncologists, urologists were less likely to report utilizing top-tier medical journals (25% vs 39%; adjusted odds ratio [OR] 0.50; P=.01) or cancer journals (22% vs 51%; adjusted OR 0.50; P<.001) but more likely to rely on clinical guidelines (46% vs 38%; adjusted OR 1.6; P=.006). Both radiation oncologists and urologists most commonly reported large randomized, clinical trials as the level of evidence to change treatment recommendations for localized prostate cancer (85% vs 77%; P=.009). Conclusions: Both specialties rely on their own specialty-specific journals and view randomized, clinical trials as the level of evidence needed to change clinical practice. Our study provides a context on meaningful ways of disseminating evidence for localized prostate cancer

The isotopic and chemical evolution of Mount St. Helens

International Nuclear Information System (INIS)

Halliday, A.N.; Fallick, A.E.; Dickin, A.P.; Mackenzie, A.B.; Stephens, W.E.

1983-01-01

Isotopic and major and trace element analysis of nine samples of eruptive products spanning the history of the Mt. St. Helens volcano suggest three different episodes; (1) 40,000-2500 years ago: eruptions of dacite with epsilonsub(Nd) = +5, epsilonsub(Sr) = -10, variable delta 18 O, 206 Pb/ 204 Pb approx.= 18.76, Ca/Sr approx.= 60, Rb/Ba- approx.= 0.1, La/Yb approx.= 18, (2) 2500-1000 years ago: eruptions of basalt, andesite and dacite with epsilonsub(Nd) = +4 to + 8, epsilonsub(Sr) = -7 to -22, variable delta 18 O (thought to represent melting of differing mantle-crust reservoirs), 206 Pb/ 204 Pb = 18.81-18.87, variable Ca/Sr, Rb/Ba, La/Yb and high Zr, (3) 1000 years ago to present day: eruptions of andesite and dacite with epsilonsub(Nd) = + 6, epsilonsub(Sr) = -13, delta 18 O approx.= 6per mille, variable 206 Pb/ 204 Pb, Ca/Sr approx.= 77, Rb/Ba = 0.1, La/Yb approx.= 11. None of the products exhibit Eu anomalies and all are LREE enriched. There is a strong correlation between 87 Sr/ 86 Sr and differentiation indices. These data are interpreted in terms of a mantle heat source melting young crust bearing zircon and garnet, but not feldspar, followed by intrusion of this crustal reservoir by mantle-derived magma which caused further crustal melting and contaminated the crustal magma system with mafic components. Since 1000 years ago all the eruptions have been from the same reservoir which has displayed a much more gradual re-equilibration of Pb isotopic compositions than other components suggesting that Pb is being transported via a fluid phase. The Nd and Sr isotopic compositions lie along the mantle array and suggest that the mantle underneath Mt. St. Helens is not as depleted as MORB sources. There is no indication of seawater involvement in the source region. (orig.)

The isotopic and chemical evolution of Mount St. Helens

Science.gov (United States)

Halliday, A.N.; Fallick, A.E.; Dickin, A.P.; Mackenzie, A.B.; Stephens, W.E.; Hildreth, W.

1983-01-01

Isotopic and major and trace element analysis of nine samples of eruptive products spanning the history of the Mt. St. Helens volcano suggest three different episodes; (1) 40,000-2500 years ago: eruptions of dacite with ??{lunate}Nd = +5, ??{lunate}Sr = -10, variable ??18O, 206Pb/204Pb ??? 18.76, Ca/Sr ??? 60, Rb/Ba ??? 0.1, La/Yb ??? 18, (2) 2500-1000 years ago: eruptions of basalt, andesite and dacite with ??{lunate}Nd = +4 to +8, ??{lunate}Sr = -7 to -22, variable ??18O (thought to represent melting of differing mantle-crust reservoirs), 206Pb/204Pb = 18.81-18.87, variable Ca/Sr, Rb/Ba, La/Yb and high Zr, (3) 1000 years ago to present day: eruptions of andesite and dacite with ??{lunate}Nd = +6, ??{lunate}Sr = -13, ??18O ???6???, variable 206Pb/204Pb, Ca/Sr ??? 77, Rb/Ba = 0.1, La/Yb ??? 11. None of the products exhibit Eu anomalies and all are LREE enriched. There is a strong correlation between 87Sr/86Sr and differentiation indices. These data are interpreted in terms of a mantle heat source melting young crust bearing zircon and garnet, but not feldspar, followed by intrusion of this crustal reservoir by mantle-derived magma which caused further crustal melting and contaminated the crustal magma system with mafic components. Since 1000 years ago all the eruptions have been from the same reservoir which has displayed a much more gradual re-equilibration of Pb isotopic compositions than other components suggesting that Pb is being transported via a fluid phase. The Nd and Sr isotopic compositions lie along the mantle array and suggest that the mantle underneath Mt. St. Helens is not as depleted as MORB sources. There is no indication of seawater involvement in the source region. ?? 1983.

Posteruption arthropod succession on the Mount St. Helens volcano: the ground-dwelling beetle fauna (Coleoptera).

Science.gov (United States)

R.R. Parmenter; C.M. Crisafulli; N. Korbe; G. Parsons; M. Edgar; J.A. MacMahon

2005-01-01

The 1980 eruptions of Mount St. Helens created a complex mosaic of disturbance types over a 600 km2 area. From 1980 through 2000 we monitored beetle species relative abundance and faunal composition of assemblages at undisturbed reference sites and in areas subjected to tephra-fall, blowdown, and pyroclastic flow volcanic disturbance. We...

Managing an Older Adult with Cancer: Considerations for Radiation Oncologists

Directory of Open Access Journals (Sweden)

Sanders Chang

2017-01-01

Full Text Available Older adults with cancer present a unique set of management complexities for oncologists and radiation oncologists. Prognosis and resilience to cancer treatments are notably dependent on the presence or risk of “geriatric syndromes,” in addition to cancer stage and histology. Recognition, proper evaluation, and management of these conditions in conjunction with management of the cancer itself are critical and can be accomplished by utilization of various geriatric assessment tools. Here we review principles of the geriatric assessment, common geriatric syndromes, and application of these concepts to multidisciplinary oncologic treatment. Older patients may experience toxicities related to treatments that impact treatment effectiveness, quality of life, treatment-related mortality, and treatment compliance. Treatment-related burdens from radiotherapy are increasingly important considerations and include procedural demands, travel, costs, and temporary or permanent loss of functional independence. An overall approach to delivering radiotherapy to an older cancer patient requires a comprehensive assessment of both physical and nonphysical factors that may impact treatment outcome. Patient and family-centered communication is also an important part of developing a shared understanding of illness and reasonable expectations of treatment.

Evaluation of radon progeny from Mount St. Helens eruptions. Final report

International Nuclear Information System (INIS)

Lepel, E.A.; Olsen, K.B.; Thomas, V.W.; Eichner, F.N.

1982-09-01

A network of twelve monitoring sites around Mount St. Helens was established to evaluate possible short-lived radioactivity in the fallen ash. Seven sites were located near major population centers of Washington and Oregon, and five sites were located within 80 km of the volcano. Each site monitored the radioactivity present by the use of thermoluminescent dosimeters which recorded the total exposure to radioactivity over the exposure period. Eruptions occurring on July 22, August 7, and October 16 to 18, 1980 were monitored. No statistically significant quantities of measurable radon daughters were observed

Recovery opportunities, work-home conflict, and emotional exhaustion among hematologists and oncologists in private practice.

Science.gov (United States)

Nitzsche, Anika; Neumann, Melanie; Groß, Sophie E; Ansmann, Lena; Pfaff, Holger; Baumann, Walter; Wirtz, Markus; Schmitz, Stephan; Ernstmann, Nicole

2017-04-01

Hematologists and oncologists in private practice play a central role in the care provided for cancer patients. The present study analyzes stress and relaxation aspects in the work of hematologists and oncologists in private practice in Germany in relation to emotional exhaustion, as a core dimension of burnout syndrome. The study focuses on the opportunities for internal recovery using breaks and time out during the working day, the frequency of working on weekends and on vacation, and the physician's work-home and home-work conflict. Postulated associations between the constructs were analyzed using a structural equation model. If work leads to conflicts in private life (work-home conflict), it is associated with greater emotional exhaustion. Working frequently at the weekend is associated with greater work-home conflict and indirectly with greater emotional exhaustion. By contrast, the availability of opportunities to relax and recover during the working day is associated with less work-home conflict and indirectly with less emotional exhaustion. These results underline the importance of internal recovery opportunities during the working day and a successful interplay between working and private life for the health of outpatient hematologists and oncologists.

Pediatric oncologist willingness to offer germline TP53 testing in osteosarcoma.

Science.gov (United States)

Shaul, Eliana; Roth, Michael; Lo, Yungtai; Geller, David S; Hoang, Bang; Yang, Rui; Malkin, David; Gorlick, Richard; Gill, Jonathan

2018-03-15

Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by mutations in the tumor-suppressor gene TP53. Osteosarcoma is a sentinel cancer in LFS. Prior studies using Sanger sequencing platforms have demonstrated that 3% of individuals with osteosarcoma harbor a mutation in TP53. New data from next-generation sequencing have demonstrated that 3.8% of patients with osteosarcoma have a known pathogenic variant, and an additional 5.7% carry exonic variants of unknown significance in TP53. Pediatric oncologists were e-mailed an anonymous 18-question survey assessing their willingness to offer TP53 germline testing to a child with osteosarcoma with or without a family history, and they were evaluated for changes in their choices with the prior data and the new data. One hundred seventy-seven pediatric oncologists (22%) responded to the survey. Respondents were more likely to offer TP53 testing to a patient with a positive family history (77.4% vs 12.4%; P offer TP53 testing once they were provided with the new data (25.4% vs 12.4%; P = .0038). The proportion of providers who responded that they were unsure increased significantly when they were presented with the new data (25.4% vs 10.2%; P = .0002). Potential implications for other family members and the possibility that surveillance imaging would detect new malignancies at an earlier stage were important factors influencing a provider's decision to offer TP53 testing. Recent data increase the proportion of providers willing to offer testing, and this suggests concern on the part of pediatric oncologists that variants of unknown significance may be disease-defining in rare cancers. Cancer 2018;124:1242-50. © 2018 American Cancer Society. © 2018 American Cancer Society.

Key diagnostic information for the oncologist

International Nuclear Information System (INIS)

Zlatareva, D.

2012-01-01

Full text: The radiologists use many modalities for imaging of oncologic patients. In order to get the most out of these imaging studies oncologist have to provide with precise information: what is the working diagnosis, what treatment the patients has had and what is the clinical question should be answered by imaging study. The main indications for imaging are confirmation of diagnosis, evaluation of the patient for surgery or assessment of response to the therapy. These will influence the choice of the test, the protocol and interpretation of the results. Imaging plays a vital role in the management of patients with cancer. It is important not only for diagnosis, indicating sites of abnormality, and guiding biopsies, but it is also crucial in assessing disease extent and thereby determining treatment. The stage of cancer at the time of diagnosis is a key factor to define prognosis and is important element in determining appropriate treatment. The most clinically used cancer staging system is tumor node metastasis (TNM). Stage is determined from information on the tumor, regional nodes, and metastases and by grouping cases with similar prognosis. The criteria for defining anatomic extent of disease are specific for tumors at different anatomic sites and of different histologic types. Therefore, the criteria for T, N and M are defined separately for each tumor and histologic type. For Hodgkin and other lymphomas, a different system for the extent of disease and prognosis is used. It is mandatory for the radiologist to learn TNM system to provide the oncologist with key diagnostic information. Learning objectives: To understand TNM staging system for the most common malignancies To review the changes from the sixth to the seven edition of the American Joint committee on cancer staging manual To describe diagnostic information provided by CT and MRI in preoperative planning and after therapy To discuss the role of PET/CT imaging in oncology

Oncologists' communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication.

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Granek, Leeat; Nakash, Ora; Cohen, Michal; Ben-David, Merav; Ariad, Samuel

2017-11-01

Oncologists must communicate effectively with patients and their families about end of life (EOL). Despite the importance of communicating on this topic, many oncologists avoid these conversations. The objective of this study was to examine the associations between secondary traumatic stress and compassion satisfaction and approach and avoidant communication about EOL with cancer patients. A convenience sample of 79 oncologists (n = 27 men, n = 52 women) participated in the study. Oncologists completed a survey that included a sociodemographic and clinical information questionnaire, the Professional Quality of Life Scale, and Communication about End of Life Survey. To examine the effect of secondary traumatic stress and compassion satisfaction on approach and avoidant communication, while controlling for gender and age, 2 hierarchical linear regression analyses were computed. Oncologists reported high levels of secondary traumatic stress and high compassion satisfaction. Scores on the approach and avoidant communication scales were in the mid-range of the scale. Lower reports of secondary traumatic stress and higher compassion satisfaction were associated with higher approach communication strategies: however, only higher secondary traumatic stress was associated with higher avoidant communication strategies. Our findings indicate that there is an association between emotional factors and approach communication. The findings have clinical implications in designing effective communication skills training. Further research and training should take secondary traumatic stress and compassion satisfaction into consideration to be able to ensure that terminal patients and their families receive the best quality EOL care. Copyright © 2016 John Wiley & Sons, Ltd.

Fermilab's Helen Edwards receives prestigious 2003 Robert R. Wilson prize from the American Physical Society

CERN Multimedia

2002-01-01

Helen Edwards has been awarded the 2003 Robert R. Wilson prize. She was cited for "her pivotal achievement and critical contribution as the leader in the design, construction, commissioning and operation of the Tevatron, and for her continued contributions to the development of high gradient superconducting linear accelerators as well as bright and intense electron sources." (1/2 page).

Implications of Patient Portal Transparency in Oncology: Qualitative Interview Study on the Experiences of Patients, Oncologists, and Medical Informaticists.

Science.gov (United States)

Alpert, Jordan M; Morris, Bonny B; Thomson, Maria D; Matin, Khalid; Brown, Richard F

2018-03-26

Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients' personal health knowledge. However, little is known about how patient portals are used in oncology. The aim of this study was to understand attitudes of the portal's adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. In-depth semistructured interviews were conducted with 60 participants: 35 patients, 13 oncologists, and 12 medical informaticists. Interviews were recorded, transcribed, and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Two primary themes were discovered: (1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists' involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; (2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another's culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. The majority of patients (54%, 19/35) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure but still preferred face-to-face or telephone communication. Findings from this study indicate that

Prevalence of the burnout syndrome among Brazilian medical oncologists

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João Glasberg

2007-02-01

Full Text Available INTRODUCTION: Burnout syndrome which is prevalent among oncologists is characterized by three aspects: emotional exhaustion, depersonalization and low personal accomplishment. The purpose was to evaluate prevalence of the burnout syndrome among Brazilian medical oncologists and the variables that correlate with its presence. METHODS: A survey was conducted with members of the Brazilian Society of Medical Oncology (SBOC who received three questionnaires (general, Maslach burnout questionnaire and an opinion survey mailed to all 458 members. RESULTS: Response rate was of 22.3%. According to the criteria proposed by Grunfeld, which consider burnout present when at least one of the aspects is severely abnormal, prevalence of this syndrome was 68.6% (95% confidence interval, CI: 58.68% to 77.45%. By multivariate analysis having a hobby/physical activity, a religious affiliation, older age, living with a companion and rating vacation time as sufficient were correlated significantly and independently with burnout syndrome. CONCLUSIONS: The burnout syndrome is prevalent among Brazilian oncologists. Oncologists having sufficient personal and social resources to engage in a hobby, physical activity, have enough vacation time and religious activities are at lower risk of developing burnout.INTRODUÇÃO: A Síndrome da Estafa Profissional (SEP é considerada uma doença caracterizada por três componentes básicos: exaustão emocional (EE, despersonalização (DP e reduzida realização pessoal (RP, sendo identificada em oncologistas. OBJETIVO: Analisar a prevalência da SEP entre oncologistas clínicos e possíveis fatores relacionados. MÉTODOS: Foram enviados três questionários (Questionário Geral, Questionário Maslach de Burnout e Questionário de Opinião para 458 cancerologistas cadastrados na Sociedade Brasileira de Oncologia Clínica (SBOC. RESULTADOS: A taxa de resposta foi de 20%. 43,3% dos entrevistados demonstraram nível baixo de EE, 57

Photogrammetric Analysis of the Current Dome-Building Eruption of Mount St. Helens Volcano

Science.gov (United States)

Diefenbach, A. K.; Dzurisin, D.; Crider, J. G.; Schilling, S. P.

2006-12-01

Beginning in October 2004 and continuing to present day, the eruption of Mount St. Helens has provided a unique opportunity to experiment with new tools and techniques to study the dome-building eruption of a Cascade volcano. At the onset of eruption, a permanent camera station called Sugar Bowl was installed on the northeast rim of the crater about 2 km from the vent. Since that time, four additional cameras have been installed on the rim and crater floor to provide continuous visual observation of dome growth and crater conditions. We have analyzed images from four of the cameras to measure variations in three-dimensional lineal growth rates of lava spines extruding from the growing dome. Using photogrammetric techniques it is possible to obtain quantitative information on the geometry and displacement of a changing topographic model, in this case the evolving dome and glaciers in the crater of Mount St. Helens. The technique is an inexpensive, high-resolution, and efficient method that uses standard commercial software and an off-the-shelf digital camera to determine the x, y, z positions of selected points on the model surface. The model geometry at any given time is defined by the positions of all the points, and displacements are measured by tracking the changing positions of the points through time. Lineal extrusion rates during the first few months of the eruption ranged from 6-11 m/d, and subsequent estimates by other techniques were 4-5 m/d (Dzurisin et. al, 2005). For the past six months the extrusion rate has leveled off at 1 m/d, possibly indicative of steady-state extrusion or an approaching pause in the eruption. Another aspect of the project involves the use of overlapping oblique photos taken from a helicopter in 2004 and 2005 to produce fast and coarse digital elevation models (DEMs), which supplement high resolution DEMs produced by the USGS every 1 - 2 months. Comparing these results with seismicity and ground tilt measured by shallow borehole

Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists.

Science.gov (United States)

Whippen, D A; Canellos, G P

1991-10-01

Burnout, the end result of stress, can occur in any profession. We set out to determine the extent of burnout among a representative group of American oncologists. A questionnaire with 12 specific points was designed and prepared by the authors. It was mailed to 1,000 randomly selected physician subscribers to the Journal of Clinical Oncology. Five hundred ninety-eight completed surveys (60%) were returned before the cut-off date and included in the analysis. Overall, 56% of the respondents reported experiencing burnout in their professional life. No significance was found between the incidence of burnout and specialty within oncology, year medical training ended, or practice location. Significance was found, however, between type of practice and the incidence of burnout; institution- or university-based oncologists reported a lower incidence of burnout (47%) versus all other types of practice (66% burnout rate for oncology plus internal medicine, 63% for private adult oncology only, 39% for pediatric oncologists [there were too few pediatric oncologists for this rate to be significant], and 64% for others; P = .0003). Frustration or a sense of failure was the most frequently chosen (56%) description of burnout, and insufficient personal and/or vacation time was the most frequent reason (57%) chosen to explain the existence of burnout. To alleviate burnout, the majority (69%) of respondents indicated the need for more vacation or personal time. Administering palliative or terminal care, reimbursement issues, and a heavy work load were identified as contributing factors to burnout. Given the high response to the questionnaire and a 56% incidence of burnout in the surveyed population, it is concluded that further research on this issue is required.

GeoGirls: A Geology and Geophysics Field Camp for Middle School Girls at Mount St. Helens

Science.gov (United States)

Samson, C.; Allstadt, K.; Melander, S.; Groskopf, A.; Driedger, C. L.; Westby, E.

2015-12-01

The August 2015 GeoGirls program was a project designed to inspire girls to gain an appreciation and enthusiasm for Earth sciences using Mount St. Helens as an outdoor volcanic laboratory. Occupations in the field of science and engineering tend to be held by more males than females. One way to address this is to introduce girls to possible opportunities within the geosciences and encourage them to learn more about the dynamic environment in which they live. In 2015, the GeoGirls program sought to accomplish this goal through organizing a five day-long field camp for twenty middle school-aged girls, along with four high school-aged mentors and two local teachers. This group explored Mount St. Helens guided by female scientists from the USGS Cascade Volcano Observatory (CVO), the Mount St. Helens Institute (MSHI), UNAVCO, Boise State, Georgia Tech, University of Washington and Oregon State University. To introduce participants to techniques used by volcanologists, the girls participated in hands-on experiments and research projects focusing on seismology, GPS, terrestrial lidar, photogrammetry, water and tephra. Participants also learned to collect samples, analyze data and use microscopes. Through this experience, participants acquired strategies for conducting research by developing hypotheses, making observations, thinking critically and sharing their findings with others. The success of the GeoGirls program was evaluated by participant and parent survey questionnaires, which allowed assessment of overall enthusiasm and interest in pursuing careers in the geosciences. The program was free to participants and was run jointly by MSHI and CVO and funded by NSF, the American Association of University Women, the Association for Women Geoscientists, the Association of Environmental & Engineering Geologists and private donors. The program will run again in the summer of 2016.

A "miracle" cancer drug in the era of social media: A survey of Brazilian oncologists' opinions and experience with phosphoethanolamine.

Science.gov (United States)

Rêgo, Juliana Florinda M; Lopes, Gilberto; Riechelmann, Rachel P; Sternberg, Cinthya; Ferrari, Claudio; Fernandes, Gustavo

2017-01-01

Patients who are treating cancer have often used alternative therapies. In the internet era, information can be broadcasted widely, and this happened with phosphoethanolamine in Brazil, where this substance was claimed by the population to be the "cure for cancer." This is a cross-sectional study developed by the Brazilian Society of Clinical Oncology (SBOC). An objectively structured questionnaire was sent by e-mail and SMS to active MDs members of the SBOC. Descriptive statistics was used to evaluate the data. Statistical significance between the variables was tested by Pearson's Chi-squared test (p<0.05 was considered significance). The survey was sent to 1,072 oncologists, and 398 (37.1%) answered at least part of it. One hundred and fifteen (28.9%) had followed patients who had used phosphoethanolamine. Among these, 14 (12.2%) observed adverse events and four (3.5%) attributed clinical benefit to the substance. Most of the oncologists (n=331; 83.2%) believe that it should only be used as part of a clinical trial protocol. Most physicians did not recommend this drug to their patients (n=311; 78.1%). Oncologists in Southeast, South and Midwest Brazil were more likely to have patients taking the drug compared to the Northern and Northeastern regions. This is the first survey to assess the opinion and experience of oncologists about this alternative therapy. Most oncologists in Brazil do not believe that synthetic phosphoethanolamine is active in cancer treatment, do not recommend its use without proper evaluation, and state that it should only be available to patients in the context of clinical trials.

Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database

Energy Technology Data Exchange (ETDEWEB)

Jairam, Vikram [Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B., E-mail: james.b.yu@yale.edu [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

2016-01-01

Purpose: To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. Methods and Materials: The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. Results: Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Conclusions: Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician–industry relationships.

Impossible Practice and Theories of the Impossible: A Response to Helene Illeris's "Potentials of Togetherness"

Science.gov (United States)

Kallio-Tavin, Mira

2014-01-01

In a recent commentary in "Studies in Art Education," Helene Illeris (2013) discussed the idea of "performative experimental communities" via a critique of visual culture pedagogy and the romanticism of community-oriented art education in Nordic countries. Illeris underpinned her arguments with Jean-Luc Nancy's (1997)…

Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

Science.gov (United States)

Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

2018-01-01

IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized

Smartphone Applications for the Clinical Oncologist in UK Practice.

Science.gov (United States)

Rozati, Hamoun; Shah, Sonya Pratik; Shah, Neha

2015-06-01

A number of medical smartphone applications have been developed to assist clinical oncology specialists. Concerns have arisen that the information provided may not be under sufficient scrutiny. This study aims to analyse the current applications available for clinical oncologists in the UK. Applications aimed specifically at physician clinical oncologists were searched for on the major smartphone operating systems: Apple iOS; Google Android; Microsoft Windows OS; and Blackberry OS. All applications were installed and analysed. The applications were scrutinised to assess the following information: cost; whether the information included was referenced; when the information was last updated; and whether they made any reference to UK guidelines. A novel rating score based on these criteria was applied to each application. Fifty applications were identified: 24 for Apple's iOS; 23 for Google's Android; 2 for Blackberry OS; and 1 for Windows OS. The categories of applications available were: drug reference; journal reference; learning; clinical calculators; decision support; guidelines; and dictionaries. Journal reference and guideline applications scored highly on our rating system. Drug reference application costs were prohibitive. Learning tools were poorly referenced and not up-to-date. Smartphones provide easy access to information. There are numerous applications devoted to oncology physicians, many of which are free and contain referenced, up-to-date data. The cost and quality of drug reference and learning applications have significant scope for improvement. A regulatory body is needed to ensure the presence of peer-reviewed, validated applications to ensure their reliability.

Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists.

Science.gov (United States)

Buckley de Meritens, Alexandre; Margolis, Benjamin; Blinderman, Craig; Prigerson, Holly G; Maciejewski, Paul K; Shen, Megan J; Hou, June Y; Burke, William M; Wright, Jason D; Tergas, Ana I

2017-09-01

We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions. Of the 145 respondents, 71% were attending physicians and 58% worked at an academic medical center. The vast majority (92%) had palliative care services available for consultation at their hospital; 48% thought that palliative care services were appropriately used, 51% thought they were underused, and 1% thought they were overused. Thirty percent of respondents thought that palliative care services should be incorporated at first recurrence, whereas 42% thought palliative care should be incorporated when prognosis for life expectancy is ≤ 6 months. Most participants (75%) responded that palliative care consultation is reasonable for symptom control at any stage of disease. Respondents were most likely to consult palliative care services for pain control (53%) and other symptoms (63%). Eighty-three percent of respondents thought that communicating prognosis is the primary team's responsibility, whereas the responsibilities for pain and symptom control, resuscitation status, and goals of care discussions were split between the primary team only and both teams. The main barrier for consulting palliative care services was the concern that patients and families would feel abandoned by the primary oncologist (73%). Ninety-seven percent of respondents answered that palliative care services are useful to improve patient care. The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a

Patient and oncologist perceptions regarding symptoms and impact on quality-of-life of oral mucositis in cancer treatment: results from the Awareness Drives Oral Mucositis PercepTion (ADOPT) study.

Science.gov (United States)

Kanagalingam, Jeevendra; Wahid, Mohamed Ibrahim A; Lin, Jin-Ching; Cupino, Nonette A; Liu, Edward; Kang, Jin-Hyoung; Bazarbashi, Shouki; Bender Moreira, Nicole; Arumugam, Harsha; Mueller, Stefan; Moon, Hanlim

2018-07-01

This descriptive cross-sectional survey aims to assess the level of concordance between the perspectives of oncologists and those of patients regarding oral mucositis (OM) symptoms, and the impact of OM on various aspects of daily living and concurrent cancer management. Oncologists involved in OM management (n = 105), and patients who developed OM during cancer treatment (n = 175), were recruited from seven Asian countries. Oncologists completed a face-to-face, quantitative interview; patients completed a face-to-face interview, and a self-reported questionnaire. Oncologists and patients ranked treatment-induced OM among the three most important toxicities of cancer therapy requiring intervention. The most frequent OM symptoms reported by patients were oral ulcers (74%), dry mouth (73%), and difficulty swallowing (62%). Oncologists expected mild OM symptoms to last slightly longer than 1 week, whereas patients reported mild symptoms for more than 2 weeks. In mild-to-moderate OM, oncologists underestimated patients' pain experience. Overall, only 45% of oncologists said they would initiate OM prophylaxis when cancer therapy started. Of the 87% of patients who said they used their prescribed medications, only 16% reported using prophylactically prescribed medication. While oncologists' concerns related to the delays and interruptions of cancer treatment, patients tended to focus on the effects of OM on eating, drinking, and talking. Oncologists' and patients' perceptions about treatment-induced OM differ. To overcome discordant perspectives, there is a need to raise general awareness and improve proactive management of OM. As noted in recent guidelines, supportive cancer care is critical for ensuring optimal therapy and for improving the patient's experience.

Mt. St. Helens' aerosols: some tropospheric and stratospheric effects

International Nuclear Information System (INIS)

Michalsky, J.J.; Stokes, G.M.

1983-01-01

Aerosol optical depth measurements based on the attenuation of direct solar radiation before and after the six major explosive eruptions of Mt. St. Helens during 1980 are presented. These automated measurements are from a site 200 km mostly east and slightly north of the volcano. From the analysis it was concluded that in several cases the conversion of sulfur gases to sulfates proceeded much more rapidly (hours) than is usually found for tropospheric conditions. A possible explanation may be the greater availability of OH due to the presence of substantial water in the plume. The second major result of the analysis was that there was no evidence of a residual aerosol burden. Turbidity data taken between eruptions in 1980 were virtually identical in terms of magnitude and wavelength dependence to 1979 turbidity

Adjuvant chemotherapy in node negative breast cancer: patterns of use and oncologists' preferences

NARCIS (Netherlands)

Stiggelbout, A. M.; de Haes, J. C.; van de Velde, C. J.

2000-01-01

BACKGROUND: A worldwide variation in policy is seen regarding adjuvant systemic treatment for node negative breast cancer (NNBC). After the first presentations of the 10-year EBCTCG results, a study was carried out in the Netherlands to assess patterns of care and to obtain the views of oncologists

Eruption prediction aided by electronic tiltmeter data at mount st. Helens.

Science.gov (United States)

Dzurisin, D; Westphal, J A; Johnson, D J

1983-09-30

Telemetry from electronic tiltmeters in the crater at Mount St. Helens contributed to accurate predictions of all six effusive eruptions from June 1981 to August 1982. Tilting of the crater floor began several weeks before each eruption, accelerated sharply for several days, and then abruptly changed direction a few minutes to days before extrusion began. Each episode of uplift was caused by the intrusion of magma into the lava dome from a shallow source, causing the dome to inflate and eventually rupture. Release of magma pressure and increased surface loading by magma added to the dome combined to cause subsidence just prior to extrusion.

On the Social Nature of Objectivity: Helen Longino and Justin Biddle

Directory of Open Access Journals (Sweden)

Jaana Eigi

2015-11-01

Full Text Available According to Helen Longino, objectivity is necessarily social as it depends on critical interactions in community. Justin Biddle argues that Longino’s account presupposes individuals that are completely open to any criticism; as such individuals are in principle able to criticise their beliefs on their own, Longino's account is not really social. In the first part of my paper I argue that even for completely open individuals, criticism for maintaining objectivity is only possible in community. In the second part I challenge Biddle’s interpretation of Longino’s conception of the individual. I conclude that Longino’s account is necessarily social.

Expert Radiation Oncologist Interpretations of Involved-Site Radiation Therapy Guidelines in the Management of Hodgkin Lymphoma

Energy Technology Data Exchange (ETDEWEB)

Hoppe, Bradford S. [University of Florida Health Proton Therapy Institute, Jacksonville, Florida (United States); Hoppe, Richard T., E-mail: rhoppe@stanford.edu [Stanford Cancer Institute, Stanford, California (United States)

2015-05-01

Purpose: Recently, involved-site radiation therapy (ISRT) guidelines have been developed and published to replace the previous concept of involved-field radiation therapy for patients with lymphoma. However, these ISRT guidelines may be interpreted in different ways, posing difficulties for prospective clinical trials. This study reports survey results regarding interpretation of the ISRT guidelines. Methods and Materials: Forty-four expert lymphoma radiation oncologists were asked to participate in a survey that included 7 different cases associated with 9 questions. The questions pertained to ISRT contouring and asked respondents to choose between 2 different answers (no “correct” answer) and a third write-in option allowed. Results: Fifty-two percent of those surveyed responded to the questionnaire. Among those who responded, 72% have practiced for >10 years, 46% have treated >20 Hodgkin lymphoma cases annually, and 100% were familiar with the ISRT concept. Among the 9 questions associated with the 7 cases, 3 had concordance among the expert radiation oncologists of greater than 70%. Six of the questions had less than 70% concordance (range, 56%-67%). Conclusions: Even among expert radiation oncologists, interpretation of ISRT guidelines is variable. Further guidance for ISRT field design will be needed to reduce variability among practicing physicians.

Polyphony and counterpoint: Mechanisms of seduction in the diaries of Helen Hessel and Henri Pierre Roché

Directory of Open Access Journals (Sweden)

Catherine du Toit

2015-06-01

Polifonie en kontrapunt: Meganismes van verleiding in die dagboeke van Helen Hessel en Henri Pierre Roché. Henri Pierre Roché (1879–1959, outeur van Jules et Jim, word beskryf as ‘n sosiale koppelaar, ‘n model-liefhebber van alles en nog wat, ‘n versamelaar van vroue en kuns en een van die mees produktiewe dagboekskrywers en aktiewe minnaars in die opgetekende geskiedenis. Roché het ‘n reeks sketse oor Don Juan gepubliseer en was geboei deur die figuur van die verleier. In sy twintigs beplan hy om sy lewe te wy aan die skepping van ‘n œuvre wat die morele, intellektuele, sosiale en seksuele verhoudings tussen mans en vrouens sou ondersoek. Ter bereiking van hierdie doel, rig hy sy lewe in as laboratorium waarin werklike ondervindinge dien as hoofbron van inligting. Sy dagboek strek oor sestig jaar en is ryk aan verhale van verleiding. Desnieteenstaande bly die mees intense en boeiende intrige van verleiding en verraad steeds sy verhouding met Helen Hessel. Aan die begin van hulle verhouding, stel Roché voor dat sy ook ‘n dagboek hou van hulle hartstogtelike liefde. Helen Hessel se dagboek, geskryf in Frans, Duits en Engels, reflekteer die drama van verleiding en funksioneer op verskillende vlakke: realisties, visionêr, ten volle geabsorbeer in haar eie gedagtes en emosies en tóg krities jeens haarself en ander. ‘n Vergelyking van die twee dagboeke skep ‘n fassinerende, digte tekstuur wat die binnewerkings blootlê van verleiding in aksie. Die kontrapunt geskep deur hierdie twee interafhanklike stemme word nóg meer kompleks namate ‘n mens bewus word van die intertekstuele verwysings wat bydra tot die ontluikende polifonie van geskrewe liefde en lewe.

Burnout among psychosocial oncologists in Israel: The direct and indirect effects of job demands and job resources.

Science.gov (United States)

Shinan-Altman, Shiri; Cohen, Miri; Rasmussen, Victoria; Turnell, Adrienne; Butow, Phyllis

2017-12-19

Psychosocial oncologists may be particularly vulnerable to burnout. This study aimed to assess burnout among Israeli psychosocial oncologists in relation to the Job Demands-Resources model and the coping strategies model. Participants included 85 of 128 listed psychosocial oncologists currently working with cancer patients. They completed a questionnaire assessing emotional exhaustion, depersonalization, job demands, job resources, work engagement, overcommitment, and perceived value of work. The mean level of burnout was low, whereas 16.3% experienced high levels of emotional exhaustion and only 2.4% experienced high levels of depersonalization. According to mediation analysis, overcommitment, partially mediated job demands-burnout associations, and work engagement mediated the perceived value-burnout association. Job resources and burnout were not related, either directly or indirectly. Significance of results The study extended the Job Demands-Resources model to include perceived value as an additional resource, and work-engagement and overcommitment as coping strategies. Two distinct patterns of associations were found between work characteristics and burnout: the positive-protective pattern (perceived value and work engagement) and the negative pattern (job demands and overcommitment). These two patterns should be considered for further research and for implementing preventive interventions to reduce burnout in the workplace setting.

Democracy and Schooling in California: The Legacy of Helen Heffernan and Corinne Seeds. Historical Studies in Education

Science.gov (United States)

Weiler, Kathleen

2011-01-01

Helen Heffernan and Corinne Seeds were nationally recognized as leaders of the progressive education movement and were key figures in what was probably the most concerted attempt to put the ideals of progressive education into practice in a state-wide system of public education in the United States. This book examines the struggle over public…

La tipología urbanística alejandrina en la ciudad helenística

Directory of Open Access Journals (Sweden)

Joaquín Montero Múñiz

2000-01-01

Full Text Available En este artículo se realiza un acercamiento al urbanismo en la Antigüedad, y más en concreto al urbanismo regular aparecido en la antigua Grecia, que encuentra su máxima expresión y difusión con las conquistas territoriales de Alejandro Magno y, posteriormente, durante los reinos helenísticos. La planificación y la fundación de nuevas ciudades durante la época helenística no sólo es un agente motor de desarrollo económico, de control político-militar del territorio o de difusión cultural, sino un factor muy importante y profundo de la propaganda política regia que más tarde seguirán empleando los emperadores romanos.In this article is carried out an approach to the urbanism in the Antiquity, and specific to the planned urbanism in Ancient Greece, that finds its máximum expression and diffusion with Alexander's the Great territorial conquests and, later on, during the Hellenistic kingdoms. The planning and foundation of new cities during the Hellenistic era are not only a motor of economic development, political and military control of the territory or cultural diffusion, but a very important and deep factor of the royal political propaganda that will be used later by the Román emperors.

Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists

Directory of Open Access Journals (Sweden)

Anusheel Munshi

2016-01-01

Conclusion: The results of the first such questionnaire based study have been presented. Most oncologists consider cell-phones a useful tool in patient care. More RO are aware of potential cell-phone hazards compared to non-RO's.

Oncologist burnout and compassion fatigue: investigating time pressure at work as a predictor and the mediating role of work-family conflict.

Science.gov (United States)

Kleiner, Sibyl; Wallace, Jean E

2017-09-11

Oncologists are at high risk of poor mental health. Prior research has focused on burnout, and has identified heavy workload as a key predictor. Compassion fatigue among physicians has generally received less attention, although medical specialties such as oncology may be especially at risk of compassion fatigue. We contribute to research by identifying predictors of both burnout and compassion fatigue among oncologists. In doing so, we distinguish between quantitative workload (e.g., work hours) and subjective work pressure, and test whether work-family conflict mediates the relationships between work pressure and burnout or compassion fatigue. In a cross-sectional study, oncologists from across Canada (n = 312) completed questionnaires assessing burnout, compassion fatigue, workload, time pressure at work, work-family conflict, and other personal, family, and occupational characteristics. Analyses use Ordinary Least Squares regression. Subjective time pressure at work is a key predictor of both burnout and compassion fatigue. Our results also show that work-family conflict fully mediates these relationships. Overall, the models explain more of the variation in burnout as compared to compassion fatigue. Our study highlights the need to consider oncologists' subjective time pressure, in addition to quantitative workload, in interventions to improve mental health. The findings also highlight a need to better understand additional predictors of compassion fatigue.

Career opportunities and benefits for young oncologists in the European Society for Medical Oncology (ESMO)

DEFF Research Database (Denmark)

Morgan, Gilberto; Lambertini, Matteo; Kourie, Hampig Raphael

2016-01-01

The European Society for Medical Oncology (ESMO) is one of the leading societies of oncology professionals in the world. Approximately 30% of the 13 000 ESMO members are below the age of 40 and thus meet the society's definition of young oncologists (YOs). ESMO has identified the training...... and development of YOs as a priority and has therefore established a comprehensive career development programme. This includes a leadership development programme to help identify and develop the future leaders in oncology. Well-trained and highly motivated future generations of multidisciplinary oncologists...... are essential to ensure the optimal evolution of the field of oncology with the ultimate goal of providing the best possible care to patients with cancer. ESMO's career development portfolio is managed and continuously optimised by several dedicated committees composed of ESMO officers and is directly...

Kas olete mõelnud välismaal õpetamisele? / Edward Kess, Helen Oppar, Sergei Ptšjolkin ... [jt.

Index Scriptorium Estoniae

2011-01-01

Küsimusele vastavad Tallinna 37. keskkooli eesti keele ja kirjanduse õpetaja Edward Kess, Varstu keskkooli loodusainete õpetaja Helen Oppar, Tallinna Mustjõe gümnaasiumi füüsikaõpetaja Sergei Ptšjolkin, Sürgavere põhikooli muusikaõpetaja Helve Tähis, Nõo reaalgümnaasiumi inglise keele õpetaja Tiina Tuuling ning Rahumäe põhikooli matemaatikaõpetaja Kadri Hiob

Database for geologic maps of pyroclastic-flow and related deposits of the 1980 eruptions of Mount St. Helens, Washington

Science.gov (United States)

Furze, Andrew J.; Bard, Joseph A.; Robinson, Joel; Ramsey, David W.; Kuntz, Mel A.; Rowley, Peter D.; MacLeod, Norman S.

2017-10-31

This publication releases digital versions of the geologic maps in U.S. Geological Survey Miscellaneous Investigations Map 1950 (USGS I-1950), “Geologic maps of pyroclastic-flow and related deposits of the 1980 eruptions of Mount St. Helens, Washington” (Kuntz, Rowley, and MacLeod, 1990) (https://pubs.er.usgs.gov/publication/i1950). The 1980 Mount St. Helens eruptions on May 18, May 25, June 12, July 22, August 7, and October 16–18 produced pyroclastic-flow and related deposits. The distribution and morphology of these deposits, as determined from extensive field studies and examination of vertical aerial photographs, are shown on four maps in I-1950 (maps A–D) on two map sheets. Map A shows the May 18, May 25, and June 12 deposits; map B shows the July 22 deposits; map C shows the August 7 deposits; and map D shows the October 16–18 deposits. No digital geospatial versions of the geologic data were made available at the time of publication of the original maps. This data release consists of attributed vector features, data tables, and the cropped and georeferenced scans from which the features were digitized, in order to enable visualization and analysis of these data in GIS software. This data release enables users to digitally re-create the maps and description of map units of USGS I-1950; map sheet 1 includes text sections (Introduction, Physiography of Mount St. Helens at the time of the 1980 eruptions, Processes of the 1980 eruptions, Deposits of the 1980 eruptions, Limitations of the maps, Preparation of the maps, and References cited) and associated tables and figures that are not included in this data release.

Attitudes of medical oncologists in Qatar toward palliative care.

Science.gov (United States)

Zeinah, Ghaith F Abu; Al-Kindi, Sadeer G; Hassan, Azza Adel

2013-09-01

The first and only palliative care (PC) unit in Qatar was established in 2008 to serve adult patients with cancer. As PC was only recently introduced to oncology practice in Qatar and the region, raising awareness among physicians is crucial. This survey study is designed to outline the level of awareness and knowledge of oncologists in Qatar toward PC. In this cross-sectional survey study, copies of a self-constructed questionnaire were distributed to 49 physicians at the National Center for Cancer Care and Research in Qatar during January 2012 and collected for data analysis. The physician response rate was 100%. Less than half of the responders (36.7%) had official training in PC, but the majority (89.8%) showed interest in the field. Only 57.8% of the physicians reported self-competence in providing good PC to the dying patient. On the other hand, up to 69.4% are aware of the guidelines for pain relief and 58.7% apply them in their clinical practice. The concept of PC hospice was familiar to 77.1% of participants. On one hand, 85.7% of the physicians advocated that every medical center should have PC service, while up to 70.8% preferred that patients with short survival expectancy die in the community, rather than in a hospital setting. There is relatively good awareness and knowledge among health care providers specialized in cancer treatment in our hospital, despite the lack of formal training. Further training and informative sessions are required to raise awareness among oncologists and encourage utilization of PC services and thus optimize patient accessibility to PC.

Communication Challenges of Oncologists and Intensivists Caring for Pediatric Oncology Patients: A Qualitative Study.

Science.gov (United States)

Odeniyi, Folasade; Nathanson, Pamela G; Schall, Theodore E; Walter, Jennifer K

2017-12-01

The families of oncology patients requiring intensive care often face increasing complexity in communication with their providers, particularly when patients are cared for by providers from different disciplines. The objective of this study was to describe experiences and challenges faced by pediatric oncologists and intensivists and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions (GCDs). We conducted semi-structured interviews with a convenience sample of 10 physicians, including pediatric oncology and intensive care attendings and fellows. We identified key themes (three barriers and four facilitators) to having GCDs with families of oncology patients who have received intensive care. Barriers included challenges to communication within teams because of hierarchy and between teams due to incomplete sharing of information and confusion about who should initiate GCDs; provider experiences of internal conflict about how to engage parents in decision-making and about the "right thing to do" for patients; and lack of education and training in communication. Facilitators included team preparation for family meetings; skills for partnering with families; the presence of palliative care specialists; and informal education in communication and willingness for further training in communication. Notably, the education theme was identified as both a barrier and resource. We identified barriers to communication with families both within and between teams and for individual physicians. Formal communication training and processes that standardize communication to ensure completeness and role delineation between clinical teams may improve oncologists' and intensivists' ability to initiate GCDs, thereby fulfilling their ethical obligations of decision support. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.

Science.gov (United States)

Puts, Martine T E; Sattar, Schroder; McWatters, Kara; Lee, Katherine; Kulik, Michael; MacDonald, Mary-Ellen; Jang, Raymond; Amir, Eitan; Krzyzanowska, Monika K; Leighl, Natasha; Fitch, Margaret; Joshua, Anthony M; Warde, Padraig; Tourangeau, Ann E; Alibhai, Shabbir M H

2017-03-01

Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70-79 and 80+). All interviews were analyzed using thematic analysis. There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists' opinion. "Trust in my oncologist" and "chemotherapy as the last resort to prolong life" were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the

End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists

Science.gov (United States)

Odejide, Oreofe O.; Salas Coronado, Diana Y.; Watts, Corey D.; Wright, Alexi A.; Abel, Gregory A.

2014-01-01

Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care. Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis. Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This difficulty was reported to result in later initiation of EOL care. Barriers to high-quality EOL care were also reported to be multifactorial, including unrealistic expectations from both physicians and patients, long-term patient-physician relationships resulting in difficulty conducting EOL discussions, and inadequacy of existing home-based EOL services. Participants also expressed concern that some EOL quality measures developed for solid tumors may be unacceptable for patients with blood cancers given their unique needs at the EOL (eg, palliative transfusions). Conclusion: Our analysis suggests that hematologic oncologists need better clinical markers for when to initiate EOL care. In addition, current quality measures may be inappropriate for identifying overly aggressive care for patients with blood cancers. Further research is needed to develop effective interventions to improve EOL care for this patient population. PMID:25294393

Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases: An International Survey of >1000 Radiation Oncologists.

Science.gov (United States)

Lewis, Stephen L; Porceddu, Sandro; Nakamura, Naoki; Palma, David A; Lo, Simon S; Hoskin, Peter; Moghanaki, Drew; Chmura, Steven J; Salama, Joseph K

2017-08-01

Stereotactic body radiotherapy (SBRT) is often used to treat patients with oligometastases (OM). Yet, patterns of SBRT practice for OM are unknown. Therefore, we surveyed radiation oncologists internationally, to understand how and when SBRT is used for OM. A 25-question survey was distributed to radiation oncologists. Respondents using SBRT for OM were asked how long they have been treating OM, number of patients treated, organs treated, primary reason for use, doses used, and future intentions. Respondents not using SBRT for OM were asked reasons why SBRT was not used and intentions for future adoption. Data were analyzed anonymously. We received 1007 surveys from 43 countries. Eighty-three percent began using SBRT after 2005 and greater than one third after 2010. Eighty-four percent cited perceived treatment response/durability as the primary reason for using SBRT in OM patients. Commonly treated organs were lung (90%), liver (75%), and spine (70%). SBRT dose/fractionation schemes varied widely. Most would offer a second course to new OM. Nearly all (99%) planned to continue and 66% planned to increase SBRT for OM. Of those not using SBRT, 59% plan to start soon. The most common reason for not using SBRT was lack of clinical efficacy (48%) or lack of necessary image guidance equipment (34%). Radiation oncologists are increasingly using SBRT for OM. The main reason for not using SBRT for OM is a perceived lack of evidence demonstrating clinical advantages. These data strengthen the need for robust prospective clinical trials (ongoing and in development) to demonstrate clinical efficacy given the widespread adoption of SBRT for OM.

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-Based Radiotherapy Target Volume Definition in Non-Small-Cell Lung Cancer: Delineation by Radiation Oncologists vs. Joint Outlining With a PET Radiologist?

International Nuclear Information System (INIS)

Hanna, Gerard G.; Carson, Kathryn J.; Lynch, Tom; McAleese, Jonathan; Cosgrove, Vivian P.; Eakin, Ruth L.; Stewart, David P.; Zatari, Ashraf; O'Sullivan, Joe M.; Hounsell, Alan R.

2010-01-01

Purpose: 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has benefits in target volume (TV) definition in radiotherapy treatment planning (RTP) for non-small-cell lung cancer (NSCLC); however, an optimal protocol for TV delineation has not been determined. We investigate volumetric and positional variation in gross tumor volume (GTV) delineation using a planning PET/CT among three radiation oncologists and a PET radiologist. Methods and Materials: RTP PET/CT scans were performed on 28 NSCLC patients (Stage IA-IIIB) of which 14 patients received prior induction chemotherapy. Three radiation oncologists and one PET radiologist working with a fourth radiation oncologist independently delineated the GTV on CT alone (GTV CT ) and on fused PET/CT images (GTV PETCT ). The mean percentage volume change (PVC) between GTV CT and GTV PETCT for the radiation oncologists and the PVC between GTV CT and GTV PETCT for the PET radiologist were compared using the Wilcoxon signed-rank test. Concordance index (CI) was used to assess both positional and volume change between GTV CT and GTV PETCT in a single measurement. Results: For all patients, a significant difference in PVC from GTV CT to GTV PETCT exists between the radiation oncologist (median, 5.9%), and the PET radiologist (median, -0.4%, p = 0.001). However, no significant difference in median concordance index (comparing GTV CT and GTV FUSED for individual cases) was observed (PET radiologist = 0.73; radiation oncologists = 0.66; p = 0.088). Conclusions: Percentage volume changes from GTV CT to GTV PETCT were lower for the PET radiologist than for the radiation oncologists, suggesting a lower impact of PET/CT in TV delineation for the PET radiologist than for the oncologists. Guidelines are needed to standardize the use of PET/CT for TV delineation in RTP.

18F-fluorodeoxyglucose positron emission tomography/computed tomography-based radiotherapy target volume definition in non-small-cell lung cancer: delineation by radiation oncologists vs. joint outlining with a PET radiologist?

Science.gov (United States)

Hanna, Gerard G; Carson, Kathryn J; Lynch, Tom; McAleese, Jonathan; Cosgrove, Vivian P; Eakin, Ruth L; Stewart, David P; Zatari, Ashraf; O'Sullivan, Joe M; Hounsell, Alan R

2010-11-15

(18)F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has benefits in target volume (TV) definition in radiotherapy treatment planning (RTP) for non-small-cell lung cancer (NSCLC); however, an optimal protocol for TV delineation has not been determined. We investigate volumetric and positional variation in gross tumor volume (GTV) delineation using a planning PET/CT among three radiation oncologists and a PET radiologist. RTP PET/CT scans were performed on 28 NSCLC patients (Stage IA-IIIB) of which 14 patients received prior induction chemotherapy. Three radiation oncologists and one PET radiologist working with a fourth radiation oncologist independently delineated the GTV on CT alone (GTV(CT)) and on fused PET/CT images (GTV(PETCT)). The mean percentage volume change (PVC) between GTV(CT) and GTV(PETCT) for the radiation oncologists and the PVC between GTV(CT) and GTV(PETCT) for the PET radiologist were compared using the Wilcoxon signed-rank test. Concordance index (CI) was used to assess both positional and volume change between GTV(CT) and GTV(PETCT) in a single measurement. For all patients, a significant difference in PVC from GTV(CT) to GTV(PETCT) exists between the radiation oncologist (median, 5.9%), and the PET radiologist (median, -0.4%, p = 0.001). However, no significant difference in median concordance index (comparing GTV(CT) and GTV(FUSED) for individual cases) was observed (PET radiologist = 0.73; radiation oncologists = 0.66; p = 0.088). Percentage volume changes from GTV(CT) to GTV(PETCT) were lower for the PET radiologist than for the radiation oncologists, suggesting a lower impact of PET/CT in TV delineation for the PET radiologist than for the oncologists. Guidelines are needed to standardize the use of PET/CT for TV delineation in RTP. Copyright © 2010 Elsevier Inc. All rights reserved.

Monitoring a restless volcano: The 2004 eruption of Mount St. Helens

Science.gov (United States)

Gardner, C.

2005-01-01

Although the precise course of volcanic activity is difficult to predict, volcanologists are pretty adept at interpreting volcanic signals from well-monitored volcanoes in order to make short-term forecasts. Various monitoring tools record effects to give us warning before eruptions, changes in eruptive behavior during eruptions, or signals that an eruption is ending. Foremost among these tools is seismic monitoring. The character, size, depth and rate of earthquakes are all important to the interpretation of what is happening belowground. The first inkling of renewed activity at Mount St. Helens began in the early hours of Sept. 23, when a seismic swarm - tens to hundreds of earthquakes over days to a week - began beneath the volcano. This article details the obervations made during the eruptive sequence.

The Myth of the Male Breadwinner: Women and Industrialization in the Caribbean by Helen I. Safa

OpenAIRE

Maurer, WM

1996-01-01

What are the implications of women's entry into the industrial workforce for their empowerment at the level of the household, workplace, and political arena? Helen Safa's book compares the experiences of women in Puerto Rico, the Dominican Republic, and Cuba to provide an insightful commentary on the gendered dimensions of the international division of labor. She documents changes in women's status as Puerto Rico and the Dominican Republic moved from import-substitution to e...

Management of Cervical Cancer: Strategies for Limited-Resource Centres - A Guide for Radiation Oncologists

International Nuclear Information System (INIS)

2013-01-01

Cervical cancer remains a significant cause of morbidity and mortality among women globally, even though it is the cancer with the greatest demonstrated potential for secondary prevention. In some regions of the world the incidence is alarmingly high, such as in sub-Saharan Africa, some countries in Latin America, India and South-East Asia. This disease is highly preventable and curable at a relatively low risk and low cost when screening of asymptomatic women is available, together with appropriate diagnosis, treatment and follow-up. In developing clinical guidelines, the International Atomic Energy Agency (IAEA) has selected forms of cancer or clinical situations that are very common in low and middle income Member States and for which radiation oncologists consistently express a need for guidance. Clinical guidelines for the management of cervical cancer do exist in the published literature. However, these guidelines have usually been developed in and for affluent environments where all modern diagnosis and treatment modalities are available for the practitioner. In limited resource environments, the radiation oncologist is faced with the question, what would be the minimally acceptable line of action with the limited resources available? Clinical guidelines focusing on low and middle income countries provide a practical tool to these practitioners. This publication is aimed at the radiation oncologist working in centres with limited resources and treating a large number of patients with cervical cancer on a daily basis. The approach and techniques are intended to be simple, feasible and resource sparing to the extent that this is possible when dealing with a complex treatment modality. The Division of Human Health is placing special emphasis on the subject of cervical cancer, which is addressed not only in this guide but also in regional training courses and coordinated research projects on the subject

Mount St. Helens ash and mud: Chemical properties and effects on germination and establishment of trees and browse plants.

Science.gov (United States)

M.A. Radwan; Dan L. Campbell

1981-01-01

Chemical properties of ash and mud from the 1980 volcanic eruption of Mount St. Helens and their effect on germination and seedling production of selected plants were studied. The volcanic materials were low in some important nutrients and cation exchange capacity, and they adversely affected seedling production. Catsear, a preferred wildlife browse, and lodgepole pine...

Differences in treatment patterns among patients with castration-resistant prostate cancer treated by oncologists versus urologists in a US managed care population

International Nuclear Information System (INIS)

Engel-Nitz, Nicole M; Alemayehu, Berhanu; Parry, David; Nathan, Faith

2011-01-01

Differences in treatment patterns, health care resource utilization, and costs between patients with castration-resistant prostate cancer (CRPC) treated by oncologists and those treated by urologists were examined. Patients aged ≥40 with CRPC were identified using claims from a large US managed health care plan between July 2001 and December 2007. A 6-month baseline period was used to assess patient characteristics. Patients with visits to an urologist, without visits to an oncologist, were assigned to the urology cohort, and patients with visits to an oncologist, with or without visits to an urologist, were assigned to the oncology cohort. Treatment patterns, health care resource utilization, and costs during a variable follow-up period were compared between cohorts using descriptive statistics and Lin’s regression. The urology cohort had fewer comorbid illnesses (P < 0.001) and patients were less likely to have other cancers during baseline (P < 0.001) or to die during follow-up (P = 0.004) compared with the oncology cohort. The oncology cohort patients were significantly more likely to have a claim for hormones (74.5% vs 61.1%; P < 0.001), chemotherapy (46.9% vs 10.2%, P < 0.001), and radiation (22.3% vs 3.7%, P < 0.0001) over follow-up. Mean unadjusted health care costs were higher in the oncology vs the urology cohort (US$31,896 vs US$15,318, respectively; P < 0.001). At 6 years follow-up, cumulative adjusted CRPC-specific costs were significantly higher among patients treated by oncologists with chemotherapy than among patients treated by urologists. CRPC patients treated by oncologists had greater use of hormones, chemotherapy, and radiation; higher percentages of patients with inpatient stays, emergency room, and ambulatory visits; and higher health care costs, than patients treated by urologists

Kuidas rasketel hetkedel käitud, kellelt nõu küsid? / Erko Karing, Monika Peetson, Helen Sildna... [jt.

Index Scriptorium Estoniae

2010-01-01

Küsimusele vastavad Guvatraki reklaamibüroo juht Erko Karing, audiitor- ja finantsnõustamisfirma Deloitte vandeaudiitor Monika Peetson, muusikapeo Tallinn Music Week peakorraldaja ja ettevõtte MUsicCase omanik Helen Sildna, ETL-Baltic Groupi juhatuse esimees ja üks loojatest Krista Mulenok, Eesti Posti e-arvete operaatori eArvekeskus juht Marius Arrak ning firma Sailinvest omanik Jaanus Tamme

Breast cancer biology for the radiation oncologist

Energy Technology Data Exchange (ETDEWEB)

Strauss, Jonathan [Northwestern Univ., Chicago, IL (United States). Dept. of Radiation Oncology; Small, William [Loyola Univ. Chicago, Maywood, IL (United States). Stritch School of Medicine, Cardianl Bernardin Cancer Center; Woloschak, Gayle E. (ed.) [Northwestern Univ. Feinberg, Chicago, IL (United States). School of Medicine

2015-10-01

This is the first textbook of its kind devoted to describing the biological complexities of breast cancer in a way that is relevant to the radiation oncologist. Radiation Oncology has long treated breast cancer as a single biological entity, with all treatment decisions being based on clinical and pathologic risk factors. We are now beginning to understand that biological subtypes of breast cancer may have different risks of recurrence as well as different intrinsic sensitivity to radiotherapy. Multi-gene arrays that have for years been used to predict the risk of distant recurrence and the value of systemic chemotherapy may also have utility in predicting the risk of local recurrence. Additionally, the targeted agents used to treat breast cancer may interact with radiotherapy in ways that can be beneficial or undesirable. All of these emerging issues are extensively discussed in this book, and practical evidence-based treatment recommendations are presented whenever possible.

Breast cancer biology for the radiation oncologist

International Nuclear Information System (INIS)

Strauss, Jonathan; Small, William; Woloschak, Gayle E.

2015-01-01

This is the first textbook of its kind devoted to describing the biological complexities of breast cancer in a way that is relevant to the radiation oncologist. Radiation Oncology has long treated breast cancer as a single biological entity, with all treatment decisions being based on clinical and pathologic risk factors. We are now beginning to understand that biological subtypes of breast cancer may have different risks of recurrence as well as different intrinsic sensitivity to radiotherapy. Multi-gene arrays that have for years been used to predict the risk of distant recurrence and the value of systemic chemotherapy may also have utility in predicting the risk of local recurrence. Additionally, the targeted agents used to treat breast cancer may interact with radiotherapy in ways that can be beneficial or undesirable. All of these emerging issues are extensively discussed in this book, and practical evidence-based treatment recommendations are presented whenever possible.

Attitudes toward end-of-life situations other than euthanasia and assisted suicide among Portuguese oncologists.

Science.gov (United States)

Gonçalves, José António Ferraz

2010-10-01

The aim of this study was to determine the attitude of Portuguese oncologists toward end-of-life situations other than euthanasia and assisted suicide. This study used a survey of 450 Portuguese oncologists by postal means and personal contact. The response rate was 33% (143). Only 7.7% doctors would give lethal doses of drugs to someone with an incurable, advanced, and progressive disease that is unable to make decisions, at the request of a family member or other close person. However, 30 doctors (21.3%) would prefer, in the event they were in such a situation, that the drugs be given them at their request. None of the 12.4% who have received such requests admitted to committing any of those acts. Almost 70% of the doctors would withdraw life support measures at the patient's request if the same had an incurable, advanced, and progressive disease, and a further 14% would do it in certain circumstances, but only 41% would withdraw measures such as nutrition and hydration. Fewer doctors would withdraw such measures including nutrition and hydration at a family member's request or on their own initiative. Religion has a major influence on the doctors' opinion. Most doctors (96.5%) agreed with the administration of drugs for symptom control even foreseeing that they could shorten life. Most Portuguese oncologists respect patients' autonomy, favoring the withdrawal of life support treatment at the patients' request when appropriate and much less do so on the request of others or by their own initiative. They appropriately do not confuse those practices with symptom relief even when hastened death can be envisaged.

Investigation and analysis of oncologists' knowledge of morphine usage in cancer pain treatment

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Liu W

2014-05-01

Full Text Available Weiran Liu,1,* Shumin Xie,2,* Lin Yue,3,* Jiahao Liu,2 Stephanie Mu-Lian Woo,4 Weilin Liu,2 Adam R Miller,5 Jing Zhang,6 Lijun Huang,7 Lei Zhang8,*1Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Anesthesia, Tianjin, People's Republic of China; 2The Xiangya Medical School of Central-South University, Changsha, People's Republic of China; 3Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Outpatient Service, Tianjin, People's Republic of China; 4Harvard University, Cambridge, MA, USA; 5Indiana University School of Medicine, Indianapolis, IN, USA; 6Tianjin Medical University, Tianjin, People's Republic of China; 7Hunan Provincial Tumor Hospital, Department of Lymphoma and Hematology, Changsha, People's Republic of China; 8Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Department of Thoracic Surgery, Tianjin, People's Republic of China *These authors contributed equally to this paperPurpose: To examine oncologists' knowledge of cancer pain and morphine's clinical application in the People's Republic of China. In addition, this study analyzes and discusses the negative factors that currently affect the clinical application of morphine.Patients and methods: A questionnaire survey was given to a random sample of 150 oncologists from Tianjin Medical University Cancer Institute and Hospital. The statistical results were analyzed and processed using SPSS version 21.0 and Matlab version 2012a statistical software. Single-factor analysis of variance, Kruskal–Wallis nonparametric test, and independent samples t-test were adopted to analyze the difference in knowledge scores of morphine usage. The study

Attenuation and scattering tomography of the deep plumbing system of Mount St. Helens

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De Siena, Luca; Thomas, Christine; Waite, Greg P.; Moran, Seth C.; Klemme, Stefan

2014-01-01

We present a combined 3-D P wave attenuation, 2-D S coda attenuation, and 3-D S coda scattering tomography model of fluid pathways, feeding systems, and sediments below Mount St. Helens (MSH) volcano between depths of 0 and 18 km. High-scattering and high-attenuation shallow anomalies are indicative of magma and fluid-rich zones within and below the volcanic edifice down to 6 km depth, where a high-scattering body outlines the top of deeper aseismic velocity anomalies. Both the volcanic edifice and these structures induce a combination of strong scattering and attenuation on any seismic wavefield, particularly those recorded on the northern and eastern flanks of the volcanic cone. North of the cone between depths of 0 and 10 km, a low-velocity, high-scattering, and high-attenuation north-south trending trough is attributed to thick piles of Tertiary marine sediments within the St. Helens Seismic Zone. A laterally extended 3-D scattering contrast at depths of 10 to 14 km is related to the boundary between upper and lower crust and caused in our interpretation by the large-scale interaction of the Siletz terrane with the Cascade arc crust. This contrast presents a low-scattering, 4–6 km2 “hole” under the northeastern flank of the volcano. We infer that this section represents the main path of magma ascent from depths greater than 6 km at MSH, with a small north-east shift in the lower plumbing system of the volcano. We conclude that combinations of different nonstandard tomographic methods, leading toward full-waveform tomography, represent the future of seismic volcano imaging.

Where Anthropology Meets History—A Review of "Tracing China: A Forty-Year Ethnographic Journey," by Helen F. Siu

Directory of Open Access Journals (Sweden)

May Bo Ching

2017-09-01

Full Text Available Helen F. Siu. Tracing China: A Forty-Year Ethnographic Journey. Hong Kong: Hong Kong University Press, 2016. ISBN: 9789888083732. For years, Helen Siu tangoed with history and trekked the fields of South China. "Tracing China: A Forty-Year Ethnographic Journey"(Hong Kong University Press, 2016—a collection of Siu’s work published over the last twenty years—is not a grandiose showpiece splotched with a lot of paint and colors. Instead, she uses a 2B pencil to leave fine marks on wafer-thin parchment and smudges them ever so slightly, gradually letting the image emerge through the back of the page. If I have understood correctly, though plurality exists in the meanings of “trace,” Siu’s intention with the title Tracing China is less to track the history of China, and more to scrupulously examine every footstep she comes across, no matter how indistinct—to “look for plum blossoms in the snow,” as the Chinese saying goes. This saying might have inspired the Chinese version of the title of the collection, one that preserves a sense of graceful subtlety...

The mechanisms of fine particle generation and electrification during Mount St. Helens volcanic eruption

Science.gov (United States)

Cheng, R. J.

1982-01-01

Microscopical investigation of volcanic ash collected from ground stations during Mount St. Helens eruptions reveal a distinctive bimodel size distribution with high concentrations of particle ranges at (1) 200-100 microns and (2) 20-0.1 microns. Close examination of individual particles shows that most larger ones are solidified magma particles of porous pumice with numerous gas bubbles in the interior and the smaller ones are all glassy fragments without any detectable gas bubbles. Elemental analysis demonstrates that the fine fragments all have a composition similar to that of the larger pumice particles. Laboratory experiments suggest that the formation of the fine fragments is by bursting of glassy bubbles from a partially solidified surface of a crystallizing molten magma particle. The production of gas bubbles is due to the release of absorbed gases in molten magma particles when solubility decreases during phase transition. Diffusion cloud chamber experiments strongly indicate that sub-micron volcanic fragments are highly hygroscopic and extremely active as cloud condensation nuclei. Ice crystals also are evidently formed on those fragments in a supercooled (-20 C) cloud chamber. It has been reported that charge generation from ocean volcanic eruptions is due to contact of molten lava with sea water. This seems to be insufficient to explain the observed rapid and intense lightning activities over Mount St. Helens eruptions. Therefore, a hypothesis is presented here that highly electrically charged fine solid fragments are ejected by bursting of gas bubbles from the surface of a crystallizing molten magma particles.

Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists.

Science.gov (United States)

Shakespeare, Thomas P

2015-11-18

Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist's clinical practice. Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8%) or post-prostatectomy (33.3%) radiotherapy, and investigation of PSA failures following definitive (16.7%) or post-prostatectomy (33.3%) radiotherapy. In 46.3% of patients PSMA was positive after negative traditional imaging, in 9.3% PSMA was positive after equivocal imaging, and in 13.0% PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3% of cases, and hormone therapy in 33.3% of patients, with an overall change in decision-making in 53.7% of patients. PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future.

Helium sources to groundwater in active volcanic terrain, and implications for tritium-helium dating at Mount St. Helens

Energy Technology Data Exchange (ETDEWEB)

Gates, John B. [Department of Earth and Atmospheric Sciences, University of Nebraska-Lincoln, 217 Bessey Hall, Lincoln NE 68588 (United States)

2013-07-01

Groundwater helium sources and residence times were investigated using groundwater discharging from springs surrounding Mount St. Helens in the Cascades region of the United States. Significant contributions of mantle helium were found in all samples and are attributable to interaction between groundwater and magmatic gases. Bounding calculations for residence times were made on the basis of helium isotope mixing plots and historical tritium data. (authors)

Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

OpenAIRE

Jacobs, M.

2015-01-01

The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and following esophageal surgery, the barriers and facilitators patients experienced when discussing their information needs with their oncologist, and the development of a web-based question prompt shee...

The importance of good death components among cancer patients, the general population, oncologists, and oncology nurses in Japan: patients prefer "fighting against cancer".

Science.gov (United States)

Miyashita, Mitsunori; Kawakami, Sachiko; Kato, Daiki; Yamashita, Hideomi; Igaki, Hiroshi; Nakano, Kimiko; Kuroda, Yujiro; Nakagawa, Keiichi

2015-01-01

The objectives of this study were to compare the importance of components of a good death among cancer patients, the general population, oncologists, and oncology nurses, and explore which patients preferred "fighting against cancer." We conducted a cross-sectional anonymous self-reported survey of cancer patients who visited a radiation oncology outpatient clinic, oncologists, and oncology nurses at the Tokyo University Hospital and a random sample of the general population in the Tokyo metropolitan area. The outcomes were 18 previously developed components of a good death in Japanese cancer care consisting of 57 attributes. Three hundred ten patients, 353 subjects from the general population, 109 oncologists, and 366 oncology nurses participated. The desire to "fight against cancer" was highly significantly different between patients and oncologists (effect size [ES] = -1.40; P = 0.001) and patients and oncology nurses (ES = -1.12; P = 0.001). "Physical and cognitive control" was, similarly, highly significantly different between patients and oncologists (ES = -1.30; P = 0.001) and patients and oncology nurses (ES = -1.06; P = 0.001). Patients who emphasized "maintaining hope and pleasure" (P = 0.0001), "unawareness of death" (P = 0.0001), and "good relationship with family" (P = 0.004) favored "fighting against cancer." The patients, however, who emphasized "physical and psychological comfort" did not significantly favor "fighting against cancer" (P = 0.004). The importance of good death components differed between groups. Medical professionals should be aware of the diversity of values surrounding death and assess the patient's values and discuss them to support his or her quality of life. In addition, the development of care and a medical/social system to maintain hope and pleasure after failure of anticancer treatment is necessary.

Current Practice Patterns Surrounding Fertility Concerns in Stage I Seminoma Patients: Survey of United States Radiation Oncologists.

Science.gov (United States)

Post, Carl M; Jain, Aditya; Degnin, Catherine; Chen, Yiyi; Craycraft, Mike; Hung, Arthur Y; Jaboin, Jerry J; Thomas, Charles R; Mitin, Timur

2018-01-16

Patients with testicular seminoma may face fertility issues because of their underlying disease as well as treatments they undergo. The current patterns of practice among U.S. radiation oncologists aimed at assessing and preserving fertility in patients with Stage I seminoma are unknown. We surveyed practicing U.S. radiation oncologists via an Institutional Review Board-approved online questionnaire. Respondents' characteristics and perceived patient infertility rates were analyzed for association with treatment recommendations. We received 353 responses, of whom one quarter (23%) consider themselves experts. A vast majority (84%) recommend observation as a default strategy. Fifty-two percent routinely advise fertility assessment for patients before observation or chemotherapy, and 74% routinely do so before adjuvant radiation therapy (RT). Forty-one percent and 43% believe that 10% and 30% of patients are infertile following orchiectomy, respectively. Thirty-seven percent and 22% believe infertility rates following para-aortic RT to be 30% and 50%, respectively. Eighty percent routinely use clamshell scrotal shielding. Responders with higher perceived infertility rates are more likely to recommend fertility assessment/sperm banking (Fisher's exact p < 0.0001). Responders who routinely advised fertility assessment were more likely to use clamshell shielding (Cochran-Armitage trend test p = 0.0007). Clamshell use was positively correlated with higher perceived infertility rates following para-aortic RT (Spearman's correlation coefficient = 0.006). Despite a clear knowledge of fertility issues in men diagnosed with seminoma, there is no universal adoption of fertility assessment among U.S. radiation oncologists.

Prostate positioning using cone-beam computer tomography based on manual soft-tissue registration. Interobserver agreement between radiation oncologists and therapists

Energy Technology Data Exchange (ETDEWEB)

Jereczek-Fossa, B.A.; Pobbiati, C.; Fanti, P. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); University of Milan, Milan (Italy); Santoro, L. [European Institute of Oncology, Department of Epidemiology and Biostatistics, Milan (Italy); Fodor, C.; Zerini, D. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); Vigorito, S. [European Institute of Oncology, Department of Medical Physics, Milan (Italy); Baroni, G. [Politecnico di Milano, Department of Electronics Information and Bioengineering, Milan (Italy); De Cobelli, O. [European Institute of Oncology, Department of Urology, Milan (Italy); University of Milan, Milan (Italy); Orecchia, R. [European Institute of Oncology, Department of Radiation Oncology, Milan (Italy); National Center for Oncological Hadrontherapy (CNAO) Foundation, Pavia (Italy); University of Milan, Milan (Italy)

2014-01-15

To check the interobserver agreement between radiation oncologists and therapists (RTT) using an on- and off-line cone-beam computer tomography (CBCT) protocol for setup verification in the radiotherapy of prostate cancer. The CBCT data from six prostate cancer patients treated with hypofractionated intensity-modulated radiotherapy (IMRT) were independently reviewed off-line by four observers (one radiation oncologist, one junior and two senior RTTs) and benchmarked with on-line CBCT positioning performed by a radiation oncologist immediately prior to treatment. CBCT positioning was based on manual soft-tissue registration. Agreement between observers was evaluated using weighted Cohen's kappa statistics. In total, 152 CBCT-based prostate positioning procedures were reviewed by each observer. The mean (± standard deviation) of the differences between off- and on-line CBCT-simCT registration translations along the three directions (antero-posterior, latero-lateral and cranio-caudal) and rotation around the antero-posterior axis were - 0.7 (3.6) mm, 1.9 (2.7) mm, 0.9 (3.6) mm and - 1.8 (5.0) degrees, respectively. Satisfactory interobserver agreement was found, being substantial (weighted kappa > 0.6) in 10 of 16 comparisons and moderate (0.41-0.60) in the remaining six comparisons. CBCT interpretation performed by RTTs is comparable to that of radiation oncologists. Our study might be helpful in the quality assurance of radiotherapy and the optimization of competencies. Further investigation should include larger sample sizes, a greater number of observers and validated methodology in order to assess interobserver variability and its impact on high-precision prostate cancer IGRT. In the future, it should enable the wider implementation of complex and evolving radiotherapy technologies. (orig.)

Mount Saint Helens, Washington, USA, SRTM Perspective: Shaded Relief and Colored Height

Science.gov (United States)

2004-01-01

Mount Saint Helens is a prime example of how Earth's topographic form can greatly change even within our lifetimes. The mountain is one of several prominent volcanoes of the Cascade Range that stretches from British Columbia, Canada, southward through Washington, Oregon, and into northern California. Mount Adams (left background) and Mount Hood (right background) are also seen in this view, which was created entirely from elevation data produced by the Shuttle Radar Topography Mission. Prior to 1980, Mount Saint Helens had a shape roughly similar to other Cascade peaks, a tall, bold, irregular conic form that rose to 2950 meters (9677 feet). However, the explosive eruption of May 18, 1980, caused the upper 400 meters (1300 feet) of the mountain to collapse, slide, and spread northward, covering much of the adjacent terrain (lower left), leaving a crater atop the greatly shortened mountain. Subsequent eruptions built a volcanic dome within the crater, and the high rainfall of this area lead to substantial erosion of the poorly consolidated landslide material. Eruptions at Mount Saint Helens subsided in 1986, but renewed volcanic activity here and at other Cascade volcanoes is inevitable. Predicting such eruptions still presents challenges, but migration of magma within these volcanoes often produces distinctive seismic activity and minor but measurable topographic changes that can give warning of a potential eruption. Three visualization methods were combined to produce this image: shading of topographic slopes, color coding of topographic height, and then projection into a perspective view. The shade image was derived by computing topographic slope in the northeast-southwest (left to right) direction, so that northeast slopes appear bright and southwest slopes appear dark. Color coding is directly related to topographic height, with green at the lower elevations, rising through yellow and tan, to white at the highest elevations. The perspective view simulates the

Integration of early specialist palliative care in cancer care: Survey of oncologists, oncology nurses, and patients

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Naveen Salins

2016-01-01

Conclusion: Oncologists, oncology nurses, and patients felt that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. The perceptions of benefit of the palliative care intervention in the components surveyed, differed among the three groups.

O desejo na Grécia Helenística

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Zeferino Rocha

Full Text Available O presente trabalho é a terceira e última parte de uma pesquisa sobre “O desejo na Grécia Antiga”. Na primeira parte, reunimos as manifestações do desejo nos poemas épicos, líricos e trágicos, bem como nas máximas dos sete sábios e na doutrina dos filósofos pré-socráticos da Grécia Arcaica. Na segunda, apresentamos o essencial da sistematização teórica que, na Grécia Clássica, Sócrates, Platão e Aristóteles deram a essas primeiras manifestações do desejo. Nesta última parte, depois de lembrar a origem e as características da cultura helenística, vamos ver o que os epicuristas e os estóicos, no contexto de suas respectivas filosofias, disseram sobre o desejo no Jardim de Epicuro e no Pórtico Antigo de Zenão e Crísipo.

Impact of social media for the hematologist/oncologist.

Science.gov (United States)

Abuhadra, Nour; Majhail, Navneet S; Nazha, Aziz

2017-10-01

In the era of modern communication, the physician and patient relationship has evolved to include an entirely new dimension-social media. This new dimension offers several opportunities for patient education, research and its dissemination, and professional development for health care providers; it can also serve as a platform for addressing important public health issues. However, these advantages come with challenges such as threats to patient and professional privacy. In this article, we dissect the benefits and drawbacks of this social evolution on the practicing hematologist-oncologist. We also perform a review of the current literature on the integration of social media in the practice of hematology/oncology; examine available guidelines for information exchange between health care professionals, industry, pharmaceutical companies, advocacy groups, and patients; and offer ways to create its seamless integration into clinical hematology-oncology practice. Copyright © 2017 Elsevier Inc. All rights reserved.

American Self-Fashioning in Helen Foster Snow's My China Years.

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Constance J. Post

2013-11-01

Full Text Available In My China Years: A Memoir, Helen Foster Snow draws upon her Puritan roots in fashioning an American self that affirms the power of an individual exemplary life, the ability to exercise free will amid struggle, an optimism borne of hope, and a way to represent failure and success. Self-fashioning, which Stephen Greenblatt attributes to the rise of an autonomous self in early modern Europe, is shaped by Snow as a distinctly American identity based on a secular Puritanism she found more congenial than the Puritanism of her ancestors on both sides of the Atlantic. The many resemblances noted by Snow between the Chinese Communist Army and seventeenth-century English Puritanism led her to interrogate Puritanism, both in its traditional form and its secularised variant. What emerges in the pages of My China Years is an attempt to fashion an American self by negotiating an old Puritanism with the new by way of a triangulation with China.

Geologic Map of the Helen Planitia Quadrangle (V-52), Venus

Science.gov (United States)

Lopez, Ivan; Hansen, Vicki L.

2008-01-01

The Magellan spacecraft orbited Venus from August 10, 1990, until it plunged into the Venusian atmosphere on October 12, 1994. Magellan Mission objectives included (1) improving the knowledge of the geological processes, surface properties, and geologic history of Venus by analysis of surface radar characteristics, topography, and morphology and (2) improving the knowledge of the geophysics of Venus by analysis of Venusian gravity. The Helen Planitia quadrangle (V-52), located in the southern hemisphere of Venus between lat 25 deg S. and 50 deg S. and between long 240 deg E. and 270 deg E., covers approximately 8,000,000 km2. Regionally, the map area is located at the southern limit of an area of enhanced tectonomagmatic activity and extensional deformation, marked by a triangle that has highland apexes at Beta, Atla, and Themis Regiones (BAT anomaly) and is connected by the large extensional belts of Devana, Hecate, and Parga Chasmata. The BAT anomaly covers approximately 20 percent of the Venusian surface.

Evaluation of the prevalence of burnout and psychological morbidity among radiation oncologist members of the Kyoto Radiation Oncology Study Group (KROSG)

International Nuclear Information System (INIS)

Mampuya, Wambaka Ange; Matsuo, Yukinori; Nakamura, Akira; Hiraoka, Masahiro

2017-01-01

This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.

Experiences and attitudes of Dutch rheumatologists and oncologists with regard to their patients' health-related Internet use

NARCIS (Netherlands)

Kraan, C.F.; Drossaert, Constance H.C.; Taal, Erik; Smit, Willem A.; Seydel, E.R.; van de Laar, Mart A F J

2010-01-01

The objective of this study is to explore the experiences and attitudes of rheumatologists and oncologists with regard to their patients’ health-related Internet use. In addition, we explored how often physicians referred their patients to health-related Internet sites. We sent a questionnaire to

Rockslide-debris avalanche of May 18, 1980, Mount St. Helens Volcano, Washington

Science.gov (United States)

Glicken, Harry

1996-01-01

This report provides a detailed picture of the rockslide-debris avalanche of the May 18, 1980, eruption of Mount St. Helens volcano. It provides a characterization of the deposit, a reinterpretation of the details of the first minutes of the eruption of May 18, and insight into the transport mechanism of the mass movement. Details of the rockslide event, as revealed by eyewitness photographs, are correlated with features of the deposit. The photographs show three slide blocks in the rockslide movement. Slide block I was triggered by a magnitude 5.1 earthquake at 8:32 a.m. Pacific Daylight Time (P.D.T.). An exploding cryptodome burst through slide block II to produce the 'blast surge.' Slide block III consisted of many discrete failures that were carried out in continuing pyroclastic currents generated from the exploding cryptodome. The cryptodome continued to depressurize after slide block III, producing a blast deposit that rests on top of the debris-avalanche deposit. The hummocky 2.5 cubic kilometer debris-avalanche deposit consists of block facies (pieces of the pre-eruption Mount St. Helens transported relatively intact) and matrix facies (a mixture of rocks from the old mountain and cryptodome dacite). Block facies is divided into five lithologic units. Matrix facies was derived from the explosively generated current of slide block III as well as from disaggregation and mixing of debris-avalanche blocks. The mean density of the old cone was measured to be abut 20 percent greater than the mean density of the avalanche deposit. Density in the deposit does not decrease with distance which suggests that debris-avalanche blocks were dilated at the mountain, rather than during transport. Various grain-size parameters that show that clast size converges about a mean with distance suggest mixing during transport. The debris-avalanche flow can be considered a grain flow, where particles -- either debris-avalanche blocks or the clasts within the blocks -- collided and

Perspectives of medical oncologists regarding music therapy for patients with cancer in Turkey - can musicology be integrated into psycho-oncology?

Science.gov (United States)

Tanriverdi, Ozgur; Aydemir, Nil Fatma

2014-01-01

Music therapy is a common complementary and alternative therapy in addition to medical treatment for patients with cancer. If music therapy, which is known has a positive effect on human emotions and behaviors, is a useful additional therapy, it should be more integrated into pyscho-oncology. In this study, we aimed to determine medical oncologist attitudes to music therapy for patients with cancer and knowledge about musicology and music therapy in Turkey. This survey study included questions about participant attitudes and knowledge regarding music therapy as well as demographic characteristics. The population of the study were 402 physicians working in medical oncology in Turkey and the sample covered 112 participants in the the survey. For statistical analyses the chi-square test, Fischer exact test, and Mann-Whitney U analysis are applied. In our study the rate for medical oncologists who were interested in music therapy was 28% (n=112). Some 30% (n=34) of medical oncologists recommended music therapy for their patients and 55% (n=61) recommended music therapy to prevent anxiety in patients with cancer. In this study, for more harmony with patients and in order to ensure management of adverse effect, it was concluded that music therapy should be regrded as an additional therapy in oncology clinics.

Redox pioneer:Professor Christine Helen Foyer.

Science.gov (United States)

Del Río, Luis A

2011-10-15

Dr. Christine Foyer (B.Sc. 1974; Ph.D. 1977) is recognized here as a Redox Pioneer because she has published an article on redox biology that has been cited more than 1000 times, 4 other articles that have been cited more than 500 times, and a further 32 articles that have been each cited more than 100 times. During her Ph.D. at the Kings College, University of London, United Kingdom, Dr. Foyer discovered that ascorbate and glutathione and enzymes linking NADPH, glutathione, and ascorbate are localized in isolated chloroplast preparations. These observations pioneered the discovery of the ascorbate-glutathione cycle, now known as Foyer-Halliwell-Asada pathway after the names of the three major contributors, a crucial mechanism for H(2)O(2) metabolism in both animals and plants. Dr. Foyer has made a very significant contribution to our current understanding of the crucial roles of ascorbate and glutathione in redox biology, particularly in relation to photosynthesis, respiration, and chloroplast and mitochondrial redox signaling networks. "My view is that science…is compulsive and you have to keep with it all the time and not get despondent when things do not work well. Being passionate about science is what carries you through the hard times so that it isn't so much work, as a hobby that you do for a living. It is the thrill of achieving a better understanding and finding real pleasure in putting new ideas together, explaining data and passing on knowledge that keeps you going no matter what!" --Prof. Christine Helen Foyer.

Helen Flanders Dunbar, John Dewey, and clinical pragmatism: reflections on method in psychosomatic medicine and bioethics.

Science.gov (United States)

Hart, Curtis W

2002-01-01

This article outlines the method utilized by physicians and major figures in the founding of Clinical Pastoral Education, Helen Flanders Dunbar, in her work of 1943, Psychosomatic Diagnosis, and relates it to the currently evolving approach in bioethics known as clinical pragmatism. It assesses Dewey's influence on both Dunbar in psychosomatic medicine and clinical pragmatism in bioethics, and illustrates the breadth of influence of the school of philosophical thought known as pragmatism with which Dewey's name and those of William James and Charles Sanders Pierce are most often identified.

Separating volcanic deformation and atmospheric signals at Mount St. Helens using Persistent Scatterer InSAR

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Welch, Mark D.; Schmidt, David A.

2017-09-01

Over the past two decades, GPS and leveling surveys have recorded cycles of inflation and deflation associated with dome building eruptions at Mount St. Helens. Due to spatial and temporal limitations of the data, it remains unknown whether any deformation occurred prior to the most recent eruption of 2004, information which could help anticipate future eruptions. Interferometric Synthetic Aperture Radar (InSAR), which boasts fine spatial resolution over large areas, has the potential to resolve pre-eruptive deformation that may have occurred, but eluded detection by campaign GPS surveys because it was localized to the edifice or crater. Traditional InSAR methods are challenging to apply in the Cascades volcanic arc because of a combination of environmental factors, and past attempts to observe deformation at Mount St. Helens were unable to make reliable observations in the crater or on much of the edifice. In this study, Persistent Scatterer InSAR, known to mitigate issues of decorrelation caused by environmental factors, is applied to four SAR data sets in an attempt to resolve localized sources of deformation on the volcano between 1995 and 2010. Many interferograms are strongly influenced by phase delay from atmospheric water vapor and require correction, evidenced by a correlation between phase and topography. To assess the bias imposed by the atmosphere, we perform sensitivity tests on a suite of atmospheric correction techniques, including several that rely on the correlation of phase delay to elevation, and explore approaches that directly estimate phase delay using the ERA-Interim and NARR climate reanalysis data sets. We find that different correction methods produce velocities on the edifice of Mount St. Helens that differ by up to 1 cm/yr due to variability in how atmospheric artifacts are treated in individual interferograms. Additionally, simple phase-based techniques run the risk of minimizing any surface deformation signals that may themselves be

Projected requirements for radiation oncologists and trainees in Australia and New Zealand to 2007

International Nuclear Information System (INIS)

Morgan, G.; Wigg, D.; Childs, J.

2000-01-01

Workloads in radiation oncology facilities in Australia and New Zealand have been increasing steadily for many years and it is anticipated that this trend will continue. In the present paper the projected number of radiation oncologists required to meet this demand to the year 2007 are estimated, along with the number of trainees required. The estimates are based on data from regular surveys by the Royal Australian and New Zealand College of Radiologists (RANZCR) for the years 1988-97 (inclusive). From these surveys profiles of numbers, age and gender of specialists and trainees are documented together with increases from the training programme and losses from retirement. It is concluded that if the current trainee numbers are increased by 12 in Australia and two in New Zealand, there will be approximately 10 radiation oncologists per million of population by the year 2007. This number is considered appropriate vue the anticipated increase in demands and complexity of treatment. Because projections too far forward are unreliable, careful monitoring of progress is essential to obtain the appropriate balance between requirement and supply. Comparisons are made with other estimates of needs including the 1998 Australian Medical Workforce Advisory Committee (AMWAC) Report and the New Zealand Clinical Agency Workforce Project Report in 1997. Copyright (1999) Blackwell Science Pty Ltd

How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?

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Bieber, Christiane; Nicolai, Jennifer; Gschwendtner, Kathrin; Müller, Nicole; Reuter, Katrin; Buchholz, Angela; Kallinowski, Birgit; Härter, Martin; Eich, Wolfgang

2018-06-01

The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification. German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.

Trophic Interactions during Primary Succession: Herbivores Slow a Plant Reinvasion at Mount St. Helens.

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Fagan, William F; Bishop, John G

2000-02-01

Lupines (Lupinus lepidus var. lobbii), the earliest plant colonists of primary successional habitats at Mount St. Helens, were expected to strongly affect successional trajectories through facilitative effects. However, their effects remain localized because initially high rates of reinvasive spread were short lived, despite widespread habitat availability. We experimentally tested whether insect herbivores, by reducing plant growth and fecundity at the edge of the expanding lupine population, could curtail the rate of reinvasion and whether those herbivores had comparable impacts in the older, more successionally advanced core region. We found that removing insect herbivores increased both the areal growth of individual lupine plants and the production of new plants in the edge region, thereby accelerating the lupine's intrinsic rate of increase at the front of the lupine reinvasion. We found no such impacts of herbivory in the core region, where low plant quality or a complex of recently arrived natural enemies may hold herbivores in check. In the context of invasion theory, herbivore-mediated decreases in lupine population growth rate in the edge region translate into decreased rates of lupine spread, which we quantify here using diffusion models. In the Mount St. Helens system, decreased rate of lupine reinvasion will result in reductions in rates of soil formation, nitrogen input, and entrapment of seeds and detritus that are likely to postpone or alter trajectories of primary succession. If the type of spatial subtleties in herbivore effects we found here are common, with herbivory focused on the edge of an expanding plant population and suppressed or ineffective in the larger, denser central region (where the plants might be more readily noticed and studied), then insect herbivores may have stronger impacts on the dynamics of primary succession and plant invasions than previously recognized.

Variations in Oncologist Recommendations for Chemotherapy for Stage IV Lung Cancer: What Is the Role of Performance Status?

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Tisnado, Diana; Malin, Jennifer; Kahn, Katherine; Landrum, Mary Beth; Fletcher, Robert; Klabunde, Carrie; Clauser, Steven; Rogers, Selwyn O; Keating, Nancy L

2016-07-01

Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care. Copyright © 2016 by American Society of Clinical Oncology.

Current status of brachytherapy in Korea: a national survey of radiation oncologists.

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Kim, Haeyoung; Kim, Joo Young; Kim, Juree; Park, Won; Kim, Young Seok; Kim, Hak Jae; Kim, Yong Bae

2016-07-01

The aim of the present study was to acquire information on brachytherapy resources in Korea through a national survey of radiation oncologists. Between October 2014 and January 2015, a questionnaire on the current status of brachytherapy was distributed to all 86 radiation oncology departments in Korea. The questionnaire was divided into sections querying general information on human resources, brachytherapy equipment, and suggestions for future directions of brachytherapy policy in Korea. The response rate of the survey was 88.3%. The average number of radiation oncologists per center was 2.3. At the time of survey, 28 centers (36.8%) provided brachytherapy to patients. Among the 28 brachytherapy centers, 15 (53.5%) were located in in the capital Seoul and its surrounding metropolitan areas. All brachytherapy centers had a high-dose rate system using (192)Ir (26 centers) or (60)Co (two centers). Among the 26 centers using (192)Ir sources, 11 treated fewer than 40 patients per year. In the two centers using (60)Co sources, the number of patients per year was 16 and 120, respectively. The most frequently cited difficulties in performing brachytherapy were cost related. A total of 21 centers had a plan to sustain the current brachytherapy system, and four centers noted plans to upgrade their brachytherapy system. Two centers stated that they were considering discontinuation of brachytherapy due to cost burdens of radioisotope source replacement. The present study illustrated the current status of brachytherapy in Korea. Financial difficulties were the major barriers to the practice of brachytherapy.

Helen Kim as New Woman and Collaborator: A Comprehensive Assessment of Korean Collaboration under Japanese Colonial Rule

Directory of Open Access Journals (Sweden)

AhRan Ellie Bae

2017-02-01

Full Text Available Although almost seventy years has passed since Korea's liberation from Japanese rule, the issue of collaboration still haunts Korea today. Attempts to resolve this issue have tended to focus attention on the traitorous actions of "collaborators" without considering the gray areas that surround their actions such as the circumstances that influenced the accused to commit their alleged traitorous acts and the intentions that drove their decisions. Helen Kim, as a "new woman" and an educator, valued the necessity of providing education for women. Yet, her efforts to realize this goal, to the contrary, forced her into actions that would later be used to construct a reputation as a Japanese collaborator. Korea's nationalist historiography has a tendency to polarize this issue by categorizing a "collaborator" as either a traitor or a patriot. However, when we take a closer look at these collaborators' lives, we discover that most collaboration happened in gray areas where it is often difficult to clearly draw a line between treason and collaboration. Helen Kim's case suggests that the issue of collaboration cannot be fully explained by nationalist historiography's framework and we must give attention to these gray areas. Through her story I hope to complicate the issue of collaboration by raising questions that address the gray areas that surround the actions of "collaborators." In doing so, I hope to challenge the nationalist historiography's propensity to oversimplify this issue and present a more nuanced understanding of it.

Anthropology in a postcolonial colony: Helen I. Safa's contribution to Puerto Rican ethnography.

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Duany, Jorge

2010-01-01

This article assesses Helen I. Safa's legacy to anthropological thought in Puerto Rico. The first part of the article locates Safa's research on the Island within a long tradition of fieldwork by U.S. scholars since the early twentieth century. More recent research, conducted mostly by Puerto Rican women anthropologists and other social scientists, has expanded upon Safa's insights on gender and work. The second part of the essay analyzes Safa's major empirical work, The Urban Poor of Puerto Rico: A Study in Development and Inequality. Above all, this book helped overcome the theoretical impasse over the culture of poverty that characterized much of urban anthropology during the 1960s and 1970s. The article concludes with an appraisal of the relevance of Safa's work for the ethnography of contemporary Puerto Rico.

Vanemate töötamine välismaal - kuidas see mõjutab lapse elu : laste ja spetsialistide tõlgendused / Helen Pärna, Karmen Lai, Taimi Tulva

Index Scriptorium Estoniae

Pärna, Helen, 1983-

2008-01-01

Artikkel tugineb Helen Pärna magistriuurimusele. Ülevaade uurimustulemustest, mis puudutavad välismaale tööle läinud lapsevanemate lapse toimetulekut argieluga ning arutletakse selle üle, kuidas lapse lahusolek vanematest võib mõjutada lapse ja vanema vahelisi suhteid

Effects of slope on the formation of dunes in dilute, turbulent pyroclastic currents: May 18th, 1980 Mt. St. Helens eruption

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Bendana, Sylvana; Brand, Brittany D.; Self, Stephen

2014-05-01

The flanks of Mt St Helens volcano (MSH) are draped with thin, cross-stratified and stratified pyroclastic density current (PDC) deposits. These are known as the proximal bedded deposits produced during the May 18th, 1980 eruption of MSH. While the concentrated portions of the afternoon PDCs followed deep topographic drainages down the steep flanks of the volcano, the dilute overriding cloud partially decoupled to develop fully dilute, turbulent PDCs on the flanks of the volcano (Beeson, D.L. 1988. Proximal Flank Facies of the May 18, 1980 Ignimbrite: Mt. St. Helens, Washington.). The deposits along the flank thus vary greatly from those found in the pumice plain, which are generally thick, massive, poorly-sorted, block-rich deposits associated with the more concentrated portions of the flow (Brand et al, accepted. Dynamics of pyroclastic density currents: Conditions that promote substrate erosion and self-channelization - Mount St Helens, Washington (USA). JVGR). We explore the influence of topography on the formation of these dilute currents and influence of slope on the currents transport and depositional mechanisms. The deposits on steeper slopes (>15°) are fines depleted relative to the proximal bedded deposits on shallower slopes (<15°). Bedform amplitude and wavelength increase with increasing slope, as does the occurrence of regressive dunes. Increasing slope causes an increase in flow velocity and thus an increase in flow turbulence. The fines depleted deposits suggest that fine ash elutriation is more efficient in flows with stronger turbulence. The longer wavelength and amplitudes suggest that bedform morphology is directly related to flow velocity, an important finding since the controls on bedform wavelength and amplitude in density stratified flows remains poorly constrained. The occurrence of regressive dunes, often interpreted as high flow-regime bedforms, on steeper slopes relative to progressive dunes on shallower slopes further attests to the

The oncologist as coordinator of the nutritional approach.

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Bozzetti, Federico

2015-04-01

Although the nutritional approach, especially when delivered through a gastric or jejunal tube or in a central vein, is handled by the nutritional support team or a specialist in nutrition, it is the responsibility of the oncologist, who knows the natural history of the disease and the impact of the oncologic therapy, to identify the potential candidates for the nutritional support, to recommend the nutritional strategy and to integrate it within the oncologic program. If gastrointestinal function is preserved, the initial nutritional approach should be through oral supplementation, followed by tube feeding if previous attempts are unsuccessful or upper gastrointestinal tract is not accessible. Parenteral nutrition is the obligatory resort when patients are (sub)obstructed but it may also be a practical way to integrate an insufficient oral nutrient intake (so called "supplemental" parenteral nutrition). Depending on the patient's condition and the disease's stage, artificial nutrition may have a "permissive" role in patients receiving aggressive oncologic therapy or represent just a supportive treatment in patients likely to succumb from starvation sooner than from tumor progression. Copyright © 2015 Elsevier Inc. All rights reserved.

Variability Among Breast Radiation Oncologists in Delineation of the Postsurgical Lumpectomy Cavity

International Nuclear Information System (INIS)

Landis, Daniel M.; Luo Weixiu; Song Jun; Bellon, Jennifer R.; Punglia, Rinaa S.; Wong, Julia S.; Killoran, Joseph H.; Gelman, Rebecca; Harris, Jay R.

2007-01-01

Purpose: Partial breast irradiation (PBI) is becoming more widely used. Accurate determination of the surgical lumpectomy cavity volume is more critical with PBI than with whole breast radiation therapy. We examined the interobserver variability in delineation of the lumpectomy cavity among four academic radiation oncologists who specialize in the treatment of breast cancer. Methods and Materials: Thirty-four lumpectomy cavities in 33 consecutive patients were evaluated. Each physician contoured the cavity and a 1.5-cm margin was added to define the planning target volume (PTV). A cavity visualization score (CVS) was assigned (1-5). To eliminate bias, the physician of record was eliminated from the analysis in all cases. Three measures of variability of the PTV were developed: average shift of the center of mass (COM), average percent overlap between the PTV of two physicians (PVO), and standard deviation of the PTV. Results: Of variables examined, pathologic resection volume was significantly correlated with CVS, with larger volumes more easily visualized. Shift of the COM decreased and PVO increased significantly as CVS increased. For CVS 4 and 5 cases, the average COM shift was 3 mm and 2 mm, respectively, and PVO was 77% and 87%, respectively. In multiple linear regression, pathologic diameter >4 cm and CVS ≥3 were significantly associated with smaller COM shift. When CVS was omitted from analysis, PVO was significantly larger with pathologic diameter ≥5 cm, days to planning <36, and older age. Conclusions: Even among radiation oncologists who specialize in breast radiotherapy, there can be substantial differences in delineation of the postsurgical radiotherapy target volume. Large treatment margins may be prudent if the cavity is not clearly defined

Which benefits and harms of preoperative radiotherapy should be addressed? A Delphi consensus study among rectal cancer patients and radiation oncologists

International Nuclear Information System (INIS)

Kunneman, Marleen; Pieterse, Arwen H.; Stiggelbout, Anne M.; Marijnen, Corrie A.M.

2015-01-01

Background and purpose: We previously found considerable variation in information provision on preoperative radiotherapy (PRT) in rectal cancer. Our aims were to reach consensus among patients and oncologists on which benefits/harms of PRT should be addressed during the consultation, and to assess congruence with daily clinical practice. Materials and methods: A four-round Delphi-study was conducted with two expert panels: (1) 31 treated rectal cancer patients and (2) 35 radiation oncologists. Thirty-seven possible benefits/harms were shown. Participants indicated whether addressing the benefit/harm was (1) essential, (2) desired, (3) not necessary, or (4) to be avoided. Consensus was assumed when ⩾80% of the panel agreed. Results were compared to 81 audio-taped consultations. Results: The panels reached consensus that six topics should be addressed in all patients (local control, survival, long term altered defecation pattern and faecal incontinence, perineal wound healing problems, advice to avoid pregnancy), three in male patients (erectile dysfunction, ejaculation disorder, infertility), and four in female patients (vaginal dryness, pain during intercourse, menopause, infertility). On average, less than half of these topics were addressed in daily clinical practice. Conclusions: This study showed substantial overlap between benefits/harms that patients and oncologists consider important to address during the consultation, and at the same time poor congruence with daily clinical practice

Dynamics of seismogenic volcanic extrusion at Mount St Helens in 2004-05

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Iverson, R.M.; Dzurisin, D.; Gardner, C.A.; Gerlach, T.M.; LaHusen, R.G.; Lisowski, M.; Major, J.J.; Malone, S.D.; Messerich, J.A.; Moran, S.C.; Pallister, J.S.; Qamar, A.I.; Schilling, S.P.; Vallance, J.W.

2006-01-01

The 2004-05 eruption of Mount St Helens exhibited sustained, near-equilibrium behaviour characterized by relatively steady extrusion of a solid dacite plug and nearly periodic shallow earthquakes. Here we present a diverse data set to support our hypothesis that these earthquakes resulted from stick-slip motion along the margins of the plug as it was forced incrementally upwards by ascending, solidifying, gas-poor magma. We formalize this hypothesis with a dynamical model that reveals a strong analogy between behaviour of the magma-plug system and that of a variably damped oscillator. Modelled stick-slip oscillations have properties that help constrain the balance of forces governing the earthquakes and eruption, and they imply that magma pressure never deviated much from the steady equilibrium pressure. We infer that the volcano was probably poised in a near-eruptive equilibrium state long before the onset of the 2004-05 eruption. ??2006 Nature Publishing Group.

Mineral dust transport toward Hurricane Helene (2006)

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Schwendike, Juliane; Jones, Sarah C.; Vogel, Bernhard; Vogel, Heike

2016-05-01

This study investigates the transport of mineral dust from its source regions in West Africa toward the developing tropical cyclone Helene (2006) and diagnoses the resulting properties of the air influencing the tropical cyclonegenesis. The model system COSMO-ART (Consortium for Small-Scale Modelling-Aerosols and Reactive Trace gases) in which the emission and transport of mineral dust as well as the radiation feedback are taken into account, was used. The emission of mineral dust between 9 and 14 September 2006 occurred in association with the relatively strong monsoon flow and northeasterly trade winds, with gust fronts of convective systems over land, and with the Atlantic inflow. Additionally, increased surface wind speed was linked to orographical effects at the Algerian Mountains, Atlas Mountains, and the Hoggar. The dust, as part of the Saharan air layer, is transported at low levels by the monsoon flow, the Harmattan, the northeasterly trade winds, and the monsoon trough, and is transported upward in the convergence zone between Harmattan and monsoon flow, in the baroclinic zone along the West African coastline, and by convection. At around 700 hPa the dust is transported by the African easterly jet. Dry and dust-free air is found to the north-northwest of the developing tropical depression due to descent in an anticyclone. Based on the model data, it was possible to distinguish between dry (from the anticyclone), dry and dusty (from the Harmattan and northeasterly trade winds), and dusty and moist air (from the monsoon flow and in the tropical depression due to convection).

Isotopic Insights Into the Degassing and Secondary Hydration Rates of Volcanic Glass From the 1980 Eruptions of Mount St. Helens

Science.gov (United States)

Seligman, A. N.; Bindeman, I. N.; Van Eaton, A. R.; Hoblitt, R. P.

2016-12-01

Following eruption, volcanic glass undergoes hydration in its depositional environment, which overprints the history of magmatic degassing recorded in the glass. However, the rates of secondary hydration of volcanic glass used for paleoclimate studies are poorly constrained. Here, we present our results of a natural experiment using products of the 1980 eruptions of Mount St. Helens. We measured the δD of extracted water and the δ18O of the bulk glass of samples collected during the dry summer months of 1980 and compared them with material resampled in August of 2015. Results demonstrate that only samples collected from the subsurface near gas escape pipes show elevated water concentrationss (near 2.0 wt.%) and low δD (-110 to -130 ‰) and δ18O (6.0 to 6.6 ‰) values, and that the initial process of secondary hydration is not always a simple addition of low δD waters at ambient temperature. On average, the 2015 surface samples have slightly higher water contents (0.1-0.2 wt.%) and similar δ18O (6.8 - 6.9 ‰) to those collected in 1980. Given the moderate vesicularity of the samples and the slow rate of surface temperature diffusion, we attribute these observations to hydration during cooling, with only little exchange after. We also compare our results to rapidly quenched air fall pumice from the May 18th eruption, which shows moderate δD values (-74 ‰) and water concentrations (0.3 wt.%) that are closer to those for the 1980 samples. Surprisingly, the 2015 surface samples show higher δD values (+15 ‰), which we attribute to any of four possibilities: (1) evaporation or (2) degassing of underlying deposits; (3) exchange of hydrogen with local vegetation; and/or (4) microlite crystallization that aided diffusion of water. Reconstructed δD-H2O trends for the Mount St. Helens samples collected in 1980 support previous studies proposing that exsolved volatiles were trapped within a rapidly rising magma that degassed at shallow depths. The dacitic Mount

Measurements of SO2 in the Mount St. Helens debris

International Nuclear Information System (INIS)

Kerr, J.B.; Evans, F.J.; Mateer, C.L.

1982-01-01

Routine measurements of ozone and SO 2 are made with the Dobson and Brewer spectrophotometers at the Atmospheric Environment Service in Downsview Ontario. On May 20 and 21, 1980, large values of column SO 2 were observed with both spectrophotometers at the time of passage of the Mount St. Helens debris. Enhanced SO 2 values were first observed at 1800Z on May 20. The maximum column amount of SO 2 measured was 0.06 cm at 2200 Z. On May 21, SO 2 values slowly decreased from 0.03 cm at 1100 Z cm to 0.01 cm at 2000Z. Typical SO 2 amounts due to pollution at the Downsview site are approximately 0.003 to 0.005 cm. At the same time of maximum SO 2 enhancement, both Dobson and Brewer spectrophotometers measured a 0.040 cm decrease of total ozone. It is not clear whether the decrease of total ozone was caused by the volcanic cloud or natural ozone variability. Air mass trajectories indicate that the altitude of the debris cloud, which passed over Downsview at the time, was between 10 km and 12 km

Is Whole-Exome Sequencing an Ethically Disruptive Technology? Perspectives of Pediatric Oncologists and Parents of Pediatric Patients With Solid Tumors.

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McCullough, Laurence B; Slashinski, Melody J; McGuire, Amy L; Street, Richard L; Eng, Christine M; Gibbs, Richard A; Parsons, D William; Plon, Sharon E

2016-03-01

It has been anticipated that physician and parents will be ill prepared or unprepared for the clinical introduction of genome sequencing, making it ethically disruptive. As a part of the Baylor Advancing Sequencing in Childhood Cancer Care study, we conducted semistructured interviews with 16 pediatric oncologists and 40 parents of pediatric patients with cancer prior to the return of sequencing results. We elicited expectations and attitudes concerning the impact of sequencing on clinical decision making, clinical utility, and treatment expectations from both groups. Using accepted methods of qualitative research to analyze interview transcripts, we completed a thematic analysis to provide inductive insights into their views of sequencing. Our major findings reveal that neither pediatric oncologists nor parents anticipate sequencing to be an ethically disruptive technology, because they expect to be prepared to integrate sequencing results into their existing approaches to learning and using new clinical information for care. Pediatric oncologists do not expect sequencing results to be more complex than other diagnostic information and plan simply to incorporate these data into their evidence-based approach to clinical practice, although they were concerned about impact on parents. For parents, there is an urgency to protect their child's health and in this context they expect genomic information to better prepare them to participate in decisions about their child's care. Our data do not support the concern that introducing genome sequencing into childhood cancer care will be ethically disruptive, that is, leave physicians or parents ill prepared or unprepared to make responsible decisions about patient care. © 2015 Wiley Periodicals, Inc.

Is Whole Exome Sequencing an Ethically Disruptive Technology? Perspectives of Pediatric Oncologists and Parents of Pediatric Patients with Solid Tumors

Science.gov (United States)

McCullough, Laurence B.; Slashinski, Melody J.; McGuire, Amy L.; Street, Richard L.; Eng, Christine M.; Gibbs, Richard A.; Parsons, D. Williams; Plon, Sharon E.

2016-01-01

Background Some anticipate that physician and parents will be ill-prepared or unprepared for the clinical introduction of genome sequencing, making it ethically disruptive. Procedure As part of the Baylor Advancing Sequencing in Childhood Cancer Care (BASIC3) study, we conducted semi-structured interviews with 16 pediatric oncologists and 40 parents of pediatric patients with cancer prior to the return of sequencing results. We elicited expectations and attitudes concerning the impact of sequencing on clinical decision-making, clinical utility, and treatment expectations from both groups. Using accepted methods of qualitative research to analyze interview transcripts, we completed a thematic analysis to provide inductive insights into their views of sequencing. Results Our major findings reveal that neither pediatric oncologists nor parents anticipate sequencing to be an ethically disruptive technology, because they expect to be prepared to integrate sequencing results into their existing approaches to learning and using new clinical information for care. Pediatric oncologists do not expect sequencing results to be more complex than other diagnostic information and plan simply to incorporate these data into their evidence-based approach to clinical practice although they were concerned about impact on parents. For parents, there is an urgency to protect their chil's health and in this context they expect genomic information to better prepare them to participate in decisions about their chil's care. Conclusion Our data do not support concern that introducing genome sequencing into childhood cancer care will be ethically disruptive, i.e., leave physicians or parents ill-prepared or unprepared to make responsible decisions about patient care. PMID:26505993

Improving patient emotional functioning and psychological morbidity: evaluation of a consultation skills training program for oncologists.

Science.gov (United States)

Girgis, Afaf; Cockburn, Jill; Butow, Phyllis; Bowman, Deborah; Schofield, Penelope; Stojanovski, Elizabeth; D'Este, Catherine; Tattersall, Martin H N; Doran, Christopher; Turner, Jane

2009-12-01

To evaluate whether a consultation skills training (CST) program with oncologists and trainees would improve skills in detecting and responding to patient distress, thereby improving their patients' emotional functioning and reducing psychological distress. Randomized-controlled trial with 29 medical and radiation oncologists from Australia randomized to CST group (n=15) or usual-care group (n=14). The CST consisted of a 1.5-day face-to-face workshop incorporating presentation of principles, a DVD modelling ideal behaviour and role-play practice, and four 1.5h monthly video-conferences. At the CST conclusion, patients of participating doctors were recruited (n=192 in CST group, n=183 in usual-care group), completing telephone surveys at baseline, 1 week and 3 months to assess quality of life, anxiety, depression and unmet psychosocial needs. Despite high patient functioning at baseline, anxiety significantly improved at 1-week follow-up in the CST group, compared to the control group. There were no statistically significant differences in emotional functioning, depression or unmet supportive care need between the groups. Consistent trends for greater improvements were observed in intervention compared to control group patients, suggesting the CST program deserves wider evaluation. Video-conferencing after a short training course may be an effective strategy for delivering CST.

The 28. Congress of the Scientific Society of US radiologists and oncologists

International Nuclear Information System (INIS)

Pereslegin, I.A.; Zolotkov, A.G.

1987-01-01

Some reports of the 28th Congress of the Scientific Society of US Radiologists and Oncologists are reviewed. Promising effect of hyperthermia and irradiation in case of superficial tumors (recurrences and metastases of mammary gland carcinoma in thoracic wall) and limited potentialities in case of internal tumors are pointed out. A matter of interest is a series of reports on ten-year controlled clinical investigations and radiotherapy in comparison with radical mastectomy at early stages of mammary gland carcinoma. The reports contain information on application of principally new methods of X-ray, combined, complex and medicinal treatment of tumor of many localizations. Some radiotherapeutic methods were renewed, in particular, method of high dose interoperational irradiation

Critical Terrorism Studies Since 11 September 2001: What Has Been Learned? Edited by David Miller, Jessie Blackbourn, Rani Dhanda and Helen Dexter. New York, NT: Routledge, 2014.

Directory of Open Access Journals (Sweden)

Mark Roberts

2014-04-01

Full Text Available Critical Terrorism Studies Since 11 September 2001: What Has Been Learned? Edited by David Miller, Jessie Blackbourn, Rani Dhanda and Helen Dexter. New York, NT: Routledge, 2014. ISBN 978-0-415-83852-8. Graphs. Tables. Sources cited. Index. Pp. viii, 144. $137.75.

Chronology and pyroclastic stratigraphy of the May 18, 1980, eruption of Mount St. Helens, Washington

Science.gov (United States)

Criswell, C. William

1987-01-01

The eruption of Mount St. Helens on May 18, 1980 can be subdivided into six phases: the paroxysmal phase I, the early Plinian phase II, the early ash flow phase III, the climactic phase IV, the late ash flow phase V, and phase VI, the activity of which consisted of a low-energy ash plume. These phases are correlated with stratigraphic subunits of ash-fall tephra and pyroclastic flow deposits. Sustained vertical discharge of phase II produced evolved dacite with high S/Cl ratios. Ash flow activity of phase III is attributed to decreases in gas content, indicated by reduced S/Cl ratios and increased clast density of the less evolved gray pumice. Climactic events are attributed to vent clearing and exhaustion of the evolved dacite.

Regional meeting of south Oncologist.Third day of Oncologic nursing

International Nuclear Information System (INIS)

2010-12-01

The organization of the Uruguayan Congress represents the greatest effort Oncology Society Medical and Pediatric Uruguay (Sompu) to contribute to the prevention, diagnosis and treatment of cancer in Uruguay. It has developed a program that includes a wide range of topics presenting the latest developments and their significance in clinical practice, through lectures, round tables, and panels-course forum. Selected scientific papers were also discussed sessions for oral and poster presentation way. To ensure a high scientific and educational level to a select group of domestic and foreign experts were invited. The 8th Congress incorporates a panel-led forum for residents and young oncologists Prevention Cancer. Furthermore Course was held on hereditary predispositions to cancer under the Continuing Medical Education Program developed by the Sompu and accredited by the Graduate School. A special meeting in the context of the Latin American Federation of Cancer Societies (FLASCA) Therapeutic Research on Cancer in .In Region Parallel Days also included third Oncology Nursing also developed

Counting, accounting, and accountability: Helen Verran's relational empiricism.

Science.gov (United States)

Kenney, Martha

2015-10-01

Helen Verran uses the term 'relational empiricism' to describe situated empirical inquiry that is attentive to the relations that constitute its objects of study, including the investigator's own practices. Relational empiricism draws on and reconfigures Science and Technology Studies' traditional concerns with reflexivity and relationality, casting empirical inquiry as an important and non-innocent world-making practice. Through a reading of Verran's postcolonial projects in Nigeria and Australia, this article develops a concept of empirical and political 'accountability' to complement her relational empiricism. In Science and an African Logic, Verran provides accounts of the relations that materialize her empirical objects. These accounts work to decompose her original objects, generating new objects that are more promising for the specific postcolonial contexts of her work. The process of decomposition is part of remaining accountable for her research methods and accountable to the worlds she is working in and writing about. This is a practice of narrating relations and learning to tell better technoscientific stories. What counts as better, however, is not given, but is always contextual and at stake. In this way, Verran acts not as participant-observer, but as participant-storyteller, telling stories to facilitate epistemic flourishing within and as part of a historically located community of practice. The understanding of accountability that emerges from this discussion is designed as a contribution, both practical and evocative, to the theoretical toolkit of Science and Technology Studies scholars who are interested in thinking concretely about how we can be more accountable to the worlds we study.

Volcano dome dynamics at Mount St. Helens: Deformation and intermittent subsidence monitored by seismicity and camera imagery pixel offsets

Science.gov (United States)

Salzer, Jacqueline T.; Thelen, Weston A.; James, Mike R.; Walter, Thomas R.; Moran, Seth C.; Denlinger, Roger P.

2016-01-01

The surface deformation field measured at volcanic domes provides insights into the effects of magmatic processes, gravity- and gas-driven processes, and the development and distribution of internal dome structures. Here we study short-term dome deformation associated with earthquakes at Mount St. Helens, recorded by a permanent optical camera and seismic monitoring network. We use Digital Image Correlation (DIC) to compute the displacement field between successive images and compare the results to the occurrence and characteristics of seismic events during a 6 week period of dome growth in 2006. The results reveal that dome growth at Mount St. Helens was repeatedly interrupted by short-term meter-scale downward displacements at the dome surface, which were associated in time with low-frequency, large-magnitude seismic events followed by a tremor-like signal. The tremor was only recorded by the seismic stations closest to the dome. We find a correlation between the magnitudes of the camera-derived displacements and the spectral amplitudes of the associated tremor. We use the DIC results from two cameras and a high-resolution topographic model to derive full 3-D displacement maps, which reveals internal dome structures and the effect of the seismic activity on daily surface velocities. We postulate that the tremor is recording the gravity-driven response of the upper dome due to mechanical collapse or depressurization and fault-controlled slumping. Our results highlight the different scales and structural expressions during growth and disintegration of lava domes and the relationships between seismic and deformation signals.

Evolving magma storage conditions beneath Mount St. Helens inferred from chemical variations in melt inclusions from the 1980-1986 and current (2004-2006) eruptions: Chapter 33 in A volcano rekindled: the renewed eruption of Mount St. Helens, 2004-2006

Science.gov (United States)

Blundy, Jon; Cashman, Katharine V.; Berlo, Kim; Sherrod, David R.; Scott, William E.; Stauffer, Peter H.

2008-01-01

Major element, trace element, and volatile concentrations in 187 glassy melt inclusions and 25 groundmass glasses from the 1980-86 eruption of Mount St. Helens are presented, together with 103 analyses of touching FE-Ti oxide pairs from the same samples. These data are used to evaluate the temporal evolution of the magmatic plumbing system beneath the volcano during 1980-86 and so provide a framework in which to interpret analyses of melt inclusions from the current (2004-2006) eruption. Major and trace element concentrations of all melt inclusions lie at the high SiO2 end of the data array defined by eruptive products of the late Quaternary age from Mount St. Helens. For several major and trace elements, the glasses define a trend that is oblique to the whole-rock trend, indicating that different mineral assemblages were responsible for the two trends. The whole-rock trend can be ascribed to differentiation of hydrous basaltic parents in a deep-seated magma reservoir, probably at depths great enough to stabilize garnet. In contrast, the glass trends were generated by closed-system crystallization of the phenocryst and microlite mineral assemblages at low pressures. The dissolved H2O content of the melt inclusions from 1980-86, as measured by the ion microprobe, ranges from 0 to 6.7 wt. percent, with the highest values obtained from the plinian phase of May 18, 1980. Water contents decrease with increasing SiO2, consistent with decompression-driven crystallization. Preliminary data for dissolved CO2 in melt inclusions from the May 18 plinian phase from August 7, 1980, indicate that XH2O in a vapor phase was approximately constant at 0.80, irrespective of H2O content, suggestive of closed-system degassing with a high bubble fraction or gas streaming through the subvolcanic system. Temperature and f

Helen Sullivan, The Communal Mind and the Master Artifice, Athènes, Stochastis Editions, 2009-2010, 725 pages.

Directory of Open Access Journals (Sweden)

Dorval Brunelle

2011-11-01

Full Text Available La petite histoire de la publication de ce gros livre, tout comme celle de son auteur d’ailleurs, est assez inusitée et mérite certainement le detour avant d’entrer dans le vif du sujet. Le contexteHelen Sullivan était historienne et sociologue; elle est née aux États-Unis en 1906 et elle est morte en Grèce, en 1992. Diplomée de la Cornell University, elle a été l’une des 15 assistant editors de la vaste Encyclopaedia of Social Sciences publiée sous la direction de Edwin R. A. Seligman à comp...

Gynecologic oncologists' attitudes and practices relating to integrative medicine: results of a nationwide AGO survey.

Science.gov (United States)

Klein, Evelyn; Beckmann, Matthias W; Bader, Werner; Brucker, Cosima; Dobos, Gustav; Fischer, Dorothea; Hanf, Volker; Hasenburg, Annette; Jud, Sebastian M; Kalder, Matthias; Kiechle, Marion; Kümmel, Sherko; Müller, Andreas; Müller, Myrjam-Alice T; Paepke, Daniela; Rotmann, Andre-Robert; Schütz, Florian; Scharl, Anton; Voiss, Petra; Wallwiener, Markus; Witt, Claudia; Hack, Carolin C

2017-08-01

The growing popularity and acceptance of integrative medicine is evident both among patients and among the oncologists treating them. As little data are available regarding health-care professionals' knowledge, attitudes, and practices relating to the topic, a nationwide online survey was designed. Over a period of 11 weeks (from July 15 to September 30, 2014) a self-administered, 17-item online survey was sent to all 676 members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie) in the German Cancer Society. The questionnaire items addressed the use of integrative therapy methods, fields of indications for them, advice services provided, level of specific qualifications, and other topics. Of the 104 respondents (15.4%) using integrative medicine, 93% reported that integrative therapy was offered to breast cancer patients. The second most frequent type of tumor in connection with which integrative therapy methods were recommended was ovarian cancer, at 80% of the participants using integrative medicine. Exercise, nutritional therapy, dietary supplements, herbal medicines, and acupuncture were the methods the patients were most commonly advised to use. There is considerable interest in integrative medicine among gynecological oncologists, but integrative therapy approaches are at present poorly implemented in routine clinical work. Furthermore there is a lack of specific training. Whether future efforts should focus on extending counseling services on integrative medicine approaches in gynecologic oncology or not, have to be discussed. Evidence-based training on integrative medicine should be implemented in order to safely guide patients in their wish to do something by themselves.

Urbanistid ja keskkonnaeksperdid: iga muudatuse eest Reidi tee projektis oleme pidanud võitlema / Helen Sooväli-Sepping, Kristi Grišakov, Mari Jüssi ; intervjueerinud Mari Peegel ; kommenteerinud Taavi Aas

Index Scriptorium Estoniae

Sooväli-Sepping, Helen, 1974-

2016-01-01

TLÜ keskkonnakorralduse professor ja linnakorralduse õppekava juht Helen Sooväli-Sepping, TTÜ maastikuarhitektuuri õppekava juht ja linnaplaneerija-urbanist Kristi Grišakov ning Stockholmi keskkonnainstituudi Tallinna keskuse liikuvus- ja keskkonnaekspert Mari Jüssi kinnitavad, et Reidi tee projekt ei ole endiselt inimsõbralik

Chronology, morphology and stratigraphy of pumiceous pyroclastic-flow (ignimbrite) deposits from the eruption of Mount St. Helens on 18 May 1983

Science.gov (United States)

Criswell, C. W.; Elston, W. E.

1984-01-01

Between 1217 and 1620 hours (PDT), on May 18, 1980, the magmatic eruption column of Mount St. Helens formed an ash fountain and pyroclastic flows dominated the eruption process over tephra ejection. Eurption-rate pulsations generally increased to a maximum at 1600 to 1700 hrs. After 1620 hrs, the eruption assumed an open-vent discharge with strong, vertical ejection of tephra. Relative eruption rates (relative mass flux rates) of the pyroclastic flows were determined by correlating sequential photographs and SLAR images, obtained during the eruption, with stratigraphy and surface morphology of the deposits.

Landscape Response to the 1980 Eruption of Mount St. Helens: Using Historical Aerial Photography to Measure Surface Change

Science.gov (United States)

Sweeney, K.; Major, J. J.

2016-12-01

Advances in structure-from-motion (SfM) photogrammetry and point cloud comparison have fueled a proliferation of studies using modern imagery to monitor geomorphic change. These techniques also have obvious applications for reconstructing historical landscapes from vertical aerial imagery, but known challenges include insufficient photo overlap, systematic "doming" induced by photo-spacing regularity, missing metadata, and lack of ground control. Aerial imagery of landscape change in the North Fork Toutle River (NFTR) following the 1980 eruption of Mount St. Helens is a prime dataset to refine methodologies. In particular, (1) 14-μm film scans are available for 1:9600 images at 4-month intervals from 1980 - 1986, (2) the large magnitude of landscape change swamps systematic error and noise, and (3) stable areas (primary deposit features, roads, etc.) provide targets for both ground control and matching to modern lidar. Using AgiSoft PhotoScan, we create digital surface models from the NFTR imagery and examine how common steps in SfM workflows affect results. Tests of scan quality show high-resolution, professional film scans are superior to office scans of paper prints, reducing spurious points related to scan infidelity and image damage. We confirm earlier findings that cropping and rotating images improves point matching and the final surface model produced by the SfM algorithm. We demonstrate how the iterative closest point algorithm, implemented in CloudCompare and using modern lidar as a reference dataset, can serve as an adequate substitute for absolute ground control. Elevation difference maps derived from our surface models of Mount St. Helens show patterns consistent with field observations, including channel avulsion and migration, though systematic errors remain. We suggest that subtracting an empirical function fit to the long-wavelength topographic signal may be one avenue for correcting systematic error in similar datasets.

The role of mycorrhizal fungi and microsites in primary succession on Mount St. Helens.

Science.gov (United States)

Titus, J; Del Moral, R

1998-03-01

This study was designed to examine the role of vesicular-arbuscular mycorrhizae (VAM) and microsites on the growth of pioneer species. Flat, rill, near-rock, and dead lupine microsites were created in plots in barren areas of the Pumice Plain of Mount St. Helens. VAM propagules were added to the soil in half of the plots. Six pioneer species were planted into both VAM and non-VAM inoculated microsites. Plants in dead lupine microsites were greater in biomass than those in flat, rill, and near-rock microsites. Significant effects of VAM on plant biomass did not occur. Microsites continue to be important to plant colonization on the Pumice Plain, but VAM do not yet appear to play an important role. This may be due to limited nutrient availability and the facultatively mycotrophic nature of the colonizing plant species. It is unlikely that VAM play an important role in successional processes in newly emplaced nutrient-poor surfaces.

Professional burnout in European young oncologists: results of the European Society for Medical Oncology (ESMO) Young Oncologists Committee Burnout Survey.

Science.gov (United States)

Banerjee, S; Califano, R; Corral, J; de Azambuja, E; De Mattos-Arruda, L; Guarneri, V; Hutka, M; Jordan, K; Martinelli, E; Mountzios, G; Ozturk, M A; Petrova, M; Postel-Vinay, S; Preusser, M; Qvortrup, C; Volkov, M N M; Tabernero, J; Olmos, D; Strijbos, M H

2017-07-01

Burnout in health care professionals could have serious negative consequences on quality of patient care, professional satisfaction and personal life. Our aim was to investigate the burnout prevalence, work and lifestyle factors potentially affecting burnout amongst European oncologists ≤40 (YOs). A survey was conducted using the validated Maslach Burnout Inventory (MBI) and additional questions exploring work/lifestyle factors. Statistical analyses were carried out to identify factors associated with burnout. Total of 737 surveys (all ages) were collected from 41 European countries. Countries were divided into six regions. Results from 595 (81%) YOs were included (81% medical oncologists; 52% trainees, 62% women). Seventy-one percent of YOs showed evidence of burnout (burnout subdomains: depersonalization 50%; emotional exhaustion 45; low accomplishment 35%). Twenty-two percent requested support for burnout during training and 74% reported no hospital access to support services. Burnout rates were significantly different across Europe (P women (60% versus 45% P = 0.0001) and low accomplishment was highest in the 26-30 age group (P balance, access to support services, living alone and inadequate vacation time remained independent burnout factors (P balance, access to support services and adequate vacation time may reduce burnout levels. Raising awareness, support and interventional research are needed. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

Science.gov (United States)

Beisecker, Analee E.; And Others

1994-01-01

Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

Regional variation in identified cancer care needs of early-career oncologists in China, India, and Pakistan.

Science.gov (United States)

Lyerly, H Kim; Fawzy, Maria R; Aziz, Zeba; Nair, Reena; Pramesh, C S; Parmar, Vani; Parikh, Purvish M; Jamal, Rozmin; Irumnaz, Azizunissa; Ren, Jun; Stockler, Martin R; Abernethy, Amy P

2015-05-01

Cancer incidence and mortality is increasing in the developing world. Inequities between low-, middle-, and high-income countries affect disease burden and the infrastructure needs in response to cancer. We surveyed early-career oncologists attending workshops in clinical research in three countries with emerging economies about their perception of the evolving cancer burden. A cross-sectional survey questionnaire was distributed at clinical trial concept development workshops held in Beijing, Lahore, Karachi, and Mumbai at major hospitals to acquire information regarding home-country health conditions and needs. A total of 100 respondents participated in the workshops held at major hospitals in the region (India = 29, China = 25, Pakistan = 42, and other = 4). Expected consensus on many issues (e.g., emergence of cancer as a significant health issue) was balanced with significant variation in priorities, opportunities, and challenges. Chinese respondents prioritized improvements in cancer-specific care and palliative care, Indian respondents favored improved cancer detection and advancing research in cancer care, and Pakistani respondents prioritized awareness of cancer and improvements in disease detection and cancer care research. For all, the most frequently cited opportunity was help in improving professional cancer education and training. Predominantly early-career oncologists attending clinical research workshops (in China, India, and Pakistan) identified needs for increasing clinical cancer research, professional education, and public awareness of cancer. Decision makers supporting efforts to reduce the burden of cancer worldwide will need to factor the specific needs and aspirations of health care providers in their country in prioritizing health policies and budgets. ©AlphaMed Press.

Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists

International Nuclear Information System (INIS)

Shakespeare, Thomas P.

2015-01-01

Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist’s clinical practice. Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8 %) or post-prostatectomy (33.3 %) radiotherapy, and investigation of PSA failures following definitive (16.7 %) or post-prostatectomy (33.3 %) radiotherapy. In 46.3 % of patients PSMA was positive after negative traditional imaging, in 9.3 % PSMA was positive after equivocal imaging, and in 13.0 % PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3 % of cases, and hormone therapy in 33.3 % of patients, with an overall change in decision-making in 53.7 % of patients. PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future

Academic and Resident Radiation Oncologists' Attitudes and Intentions Regarding Radiation Therapy near the End of Life.

Science.gov (United States)

Lloyd, Shane; Dosoretz, Arie P; Yu, James B; Evans, Suzanne B; Decker, Roy H

2016-02-01

There has been increasing scrutiny about cancer treatment for patients very near the end of life (EoL), yet a substantial number receive palliative radiation therapy (RT) in this setting. Our aim was to document the attitudes and intentions of thought leaders and trainees in giving RT near the EoL. We distributed an anonymous survey to 473 radiation oncologists and residents. The survey examined the clinical and psychosocial factors considered as well as intentions and expectations in the delivery of RT near the EoL. Factors surrounding unfinished treatment courses, and the formative factors that shape opinions about RT at the EoL were also explored. We received 139 responses (29%). Eighty-nine percent of respondents worked at academic institutions. The factors that respondents most often consider very or extremely important to offer RT near the EoL were the preference of the patient to be treated (94%), the ability to tolerate treatment (88%), and palliative intent (70%). After instances when their patients were unable to complete treatment near the EoL, 42% of respondents said they would prescribe a shorter treatment the next time they see a similar patient. Personal experience (71%) was most often listed as very or extremely important in shaping their opinions about RT near the EoL. Survey respondents, 89% of whom were academic radiation oncologists, have a positive view of palliative RT near the EoL. They favor shorter fractionation for patients near the EoL. Personal experience is most important in shaping practices and attitudes.

Data from a professional society placement service as a measure of the employment market for radiation oncologists

International Nuclear Information System (INIS)

Bhargavan, Mythreyi; Sunshine, Jonathan H.; Schepps, Barbara

2002-01-01

Purpose: To aid in understanding the employment market for radiation oncologists, we present annual data for 1991 to 2000 from the American College of Radiology's placement service, the Professional Bureau. This data series is twice as long as any previously available. Secondarily, we compare these data with other data on the employment market. Methods and Materials: The trends in job listings, job seekers, and listings per seeker in the Bureau are tabulated and graphed. We calculate correlations and graph relationships between the last of these and measures of the job market calculated from annual surveys. Results: Bureau data show listings per job seeker declined from 0.53 in 1991 to a nadir of 0.30 in 1995 and then recovered to 1.48 in 2000. Bureau listings and job seekers, each considered separately, show a similar pattern of job market decline and then eventual recovery to better than the 1991 situation. Bureau listings per job seeker correlate 0.895 with a survey-derived index of program directors' perceptions of the job market, but statistical significance is limited (p=0.04), because very few years of survey data are available. Conclusions: The employment market for radiation oncologists weakened in the first half of the 1990s, as had been widely reported; we present the first systematic data showing this. Data from a professional society placement service provide useful and inexpensive information on the employment market

An Innovative Tool for Intraoperative Electron Beam Radiotherapy Simulation and Planning: Description and Initial Evaluation by Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

Pascau, Javier, E-mail: jpascau@mce.hggm.es [Unidad de Medicina y Cirugia Experimental, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Departamento de Bioingenieria e Ingenieria Aeroespacial, Universidad Carlos III de Madrid, Madrid (Spain); Santos Miranda, Juan Antonio [Servicio de Oncologia Radioterapica, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Facultad de Medicina, Universidad Complutense de Madrid, Madrid (Spain); Calvo, Felipe A. [Servicio de Oncologia Radioterapica, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Facultad de Medicina, Universidad Complutense de Madrid, Madrid (Spain); Departamento de Oncologia, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Bouche, Ana; Morillo, Virgina [Consorcio Hospitalario Provincial de Castellon, Castellon (Spain); Gonzalez-San Segundo, Carmen [Servicio de Oncologia Radioterapica, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Facultad de Medicina, Universidad Complutense de Madrid, Madrid (Spain); Ferrer, Carlos; Lopez Tarjuelo, Juan [Consorcio Hospitalario Provincial de Castellon, Castellon (Spain); and others

2012-06-01

Purpose: Intraoperative electron beam radiation therapy (IOERT) involves a modified strategy of conventional radiation therapy and surgery. The lack of specific planning tools limits the spread of this technique. The purpose of the present study is to describe a new simulation and planning tool and its initial evaluation by clinical users. Methods and Materials: The tool works on a preoperative computed tomography scan. A physician contours regions to be treated and protected and simulates applicator positioning, calculating isodoses and the corresponding dose-volume histograms depending on the selected electron energy. Three radiation oncologists evaluated data from 15 IOERT patients, including different tumor locations. Segmentation masks, applicator positions, and treatment parameters were compared. Results: High parameter agreement was found in the following cases: three breast and three rectal cancer, retroperitoneal sarcoma, and rectal and ovary monotopic recurrences. All radiation oncologists performed similar segmentations of tumors and high-risk areas. The average applicator position difference was 1.2 {+-} 0.95 cm. The remaining cancer sites showed higher deviations because of differences in the criteria for segmenting high-risk areas (one rectal, one pancreas) and different surgical access simulated (two rectal, one Ewing sarcoma). Conclusions: The results show that this new tool can be used to simulate IOERT cases involving different anatomic locations, and that preplanning has to be carried out with specialized surgical input.

Perceptions and practices regarding women's vaginal health following radiation therapy: A survey of radiation oncologists practicing in the United States.

Science.gov (United States)

Kachnic, Lisa A; Bruner, Deborah W; Qureshi, Muhammad M; Russo, Gregory A

Vaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT). A 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment, and impact of VS on women's sexual health was distributed to radiation oncologists. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses. A total of 233 (10.5%) participants completed the entire survey. Twelve percent, 21%, and 68% report treating gynecologic (GYN) tumors only, non-GYN pelvic tumors only, or both, respectively. Regarding risk factors, 78% believed that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy alone, and 98% by combined pelvic RT and vaginal brachytherapy. Approximately one-half of respondents felt that being postmenopausal and having a hysterectomy before radiation therapy were risk factors for VS, whereas the other half felt that these were not risk factors. All respondents agreed that VS is a clinical diagnosis. Respondents indicated that VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85%, and 72%, respectively); 65% indicated all 4. The most commonly recommended treatment for VS is vaginal dilator use. Radiation oncologists who treat GYN-only versus non-GYN cancers were more likely to perform a vaginal examination, to distribute written instructions regarding vaginal dilator use (P = .002), to have vaginal bleeding reported after RT (P = .001), and to refer patients to a sexual counselor (P = .007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS. This is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS and strategies for its prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on

Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

NARCIS (Netherlands)

Jacobs, M.

2015-01-01

The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and

Best medical practice: viewpoint of a UK oncologist.

Science.gov (United States)

Stoll, B

1989-01-01

In a clinician's view, best medical practice has two distinct meanings in a tax-funded health system: optimal management as expected by the individual patient; or, the best possible within the economic limits dictated by the society. Based on this viewpoint, this article represents an oncologist's perspective on the meaning of best medical practice in the management of patients suffering from cancer, the extent to which it is achieved in the UK health system, and how far some of the present deficiencies may be overcome. There is urgent need for medical audit in the management of cancer patients in the UK because the traditional clinical freedom of doctors can lead to wide variations in management without corresponding differences in outcome as measured by benefit to the patient. We need consensus by physicians on the guidelines for optimal management of different types of cancer at various stages, both to avoid overtreatment of the individual patient and also to direct scarce resources to their most effective use. Physicians also need to agree on guidelines for giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non-explicit rationing system, each individual competes with every other. In the case of even more difficult ethical choices, a multidisciplinary national committee is required to advise on decision-making and its views need to be debated by the general public.

Physical and chemical characteristics of Mt. St. Helens airborne debris

International Nuclear Information System (INIS)

Sedlacek, W.A.; Heiken, G.H.; Mroz, E.J.; Gladney, E.S.; Perrin, D.R.; Leifer, R.; Fisenne, I.; Hinchliffe, L.; Chuan, R.L.

1980-01-01

Tephra and aerosols from the May 18, 1980 eruption of Mt. St. Helens, Washington were sampled in the lower stratosphere with a WB-57F aircraft. The main body of the plume was intercepted over western Kansas on May 20, 48 hours after the eruption, at an altitude of 15.2 km. Concentrations on filter samples were 26 ng of SO 4 /g of air and 579 ng of ash/g of air. Angular glass pyroclasts ranged in size from 0.5 to 10 μm, with a mean grain size of 2 μm. Samples collected at altitudes of 16.7 and 12.5 km had only traces of SO 4 and ash. A second flight was flown, 72 hours after the eruption, on May 21. From north Texas to central Wyoming, at an altitude of 15.2 km, 4 /g of air were sampled. At an altitude of 18.3 km, from central Wyoming to NW New Mexico, the plume density and character were variable. Glassy pyroclasts similar to those sampled on the first flight range in size from 0.5 to 4 μm dia. Trace element analysis revealed some volatile element enrichment, but far less than previously observed in the plume from St. Augustine Volcano, 1976. Values of 210 Po/ 210 Pb were 0.7 to 1.32 comparable to the secular equilibrium value of 1.0 and far less than ratios previously reported by Lambert

Sediment erosion and delivery from Toutle River basin after the 1980 eruption of Mount St. Helens: A 30-year perspective

Science.gov (United States)

Major, Jon J.; Mosbrucker, Adam; Spicer, Kurt R.; Crisafulli, Charles; Dale, V.

2018-01-01

Exceptional sediment yields persist in Toutle River valley more than 30 years after the major 1980 eruption of Mount St. Helens. Differencing of decadal-scale digital elevation models shows the elevated load comes largely from persistent lateral channel erosion across the debris-avalanche deposit. Since the mid-1980s, rates of channel-bed-elevation change have diminished, and magnitudes of lateral erosion have outpaced those of channel incision. A digital elevation model of difference from 1999 to 2009 shows erosion across the debris-avalanche deposit is more spatially distributed compared to a model from 1987 to 1999, in which erosion was strongly focused along specific reaches of the channel.

Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg

Directory of Open Access Journals (Sweden)

Laila Paruk

2016-06-01

Full Text Available Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year. Methods: A retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment, length of stay and follow-up of a group of inpatients during 2010 with a diagnosis of BPD, based on DSM-IV-TR diagnostic criteria, allocated on discharge. Results: Considering evidence retrospectively, the quality of the BPD diagnosis allocated appeared adequate. Statistical analysis revealed findings mainly in keeping with other reports, for example, that patients with BPD are above-average users of resources who make significantly more use of emergency services and that they generally do not adhere well to their scheduled outpatient follow-up arrangements. The longer average length of inpatient stay of this group with BPD, however, exceeded the typically brief period generally recommended for acute inpatient containment and emergency intervention. Conclusion: Implementation of targeted prevention and early intervention strategies, based on systematised programmes such as dialectical behavioural therapy and mentalisation based therapy, may be useful in addressing these problems experienced with integrating the in- and outpatient management of BPD. Keywords: Borderline personality; inpatient; acute

Temporal changes in stress preceding the 2004-2008 eruption of Mount St. Helens, Washington

Science.gov (United States)

Lehto, H.L.; Roman, D.C.; Moran, S.C.

2010-01-01

The 2004-2008 eruption of Mount St. Helens (MSH), Washington, was preceded by a swarm of shallow volcano-tectonic earthquakes (VTs) that began on September 23, 2004. We calculated locations and fault-plane solutions (FPS) for shallow VTs recorded during a background period (January 1999 to July 2004) and during the early vent-clearing phase (September 23 to 29, 2004) of the 2004-2008 eruption. FPS show normal and strike-slip faulting during the background period and on September 23; strike-slip and reverse faulting on September 24; and a mixture of strike-slip, reverse, and normal faulting on September 25-29. The orientation of ??1 beneath MSH, as estimated from stress tensor inversions, was found to be sub-horizontal for all periods and oriented NE-SW during the background period, NW-SE on September 24, and NE-SW on September 25-29. We suggest that the ephemeral ~90?? change in ??1 orientation was due to intrusion and inflation of a NE-SW-oriented dike in the shallow crust prior to the eruption onset. ?? 2010 Elsevier B.V.

Women with breast cancer report substantially more disease- and treatment-related side or late effects than registered by clinical oncologists: a cross-sectional study of a standard follow-up program in an oncological department.

Science.gov (United States)

Ellegaard, Mai-Britt Bjørklund; Grau, Cai; Zachariae, Robert; Jensen, Anders Bonde

2017-08-01

Follow-up after breast cancer treatment is standard due to the risk of development of new primary cancers and recurrent disease. The aim of the present study was to evaluate a standard follow-up program in an oncological department by assessing: (1) Symptoms or signs of new primary cancer or recurrent disease, (2) Disease- and treatment-related physical and psychosocial side or late effects, and (3) relevant actions by oncology staff. In a cross-sectional study, 194 women who came for follow-up visit after treatment for primary surgery were included. The clinical oncologists registered symptoms and signs of recurrent disease or new primary cancer. Side or late effects were both assessed by patient and the clinical oncologists. Loco-regional or distant signs of recurrent disease were suspected in eight (5%) patients. Further examinations revealed no disease recurrence. Most patients (93%) reported some degree of side or late effects. Statistically significant more side or late effects were reported by the women (average: 6.9) than registered by the clinical oncologists (average: 2.4), p effects were hot flushes (35%), fatigue (32%), and sleep disturbance (31%). None of the scheduled or additional visits resulted in detection of recurrent disease. Furthermore, the majority of patients reported side or late effects. Statistically significant more women reported side or late effects than registered by the clinical oncologists. This suggests the need for rethinking of the follow-up programs with more emphasis upon side or late effects of the treatment.

Ambient noise tomography across Mount St. Helens using a dense seismic array

KAUST Repository

Wang, Yadong

2017-05-08

We investigated upper crustal structure with data from a dense seismic array deployed around Mount St. Helens for 2 weeks in the summer of 2014. Interstation cross correlations of ambient seismic noise data from the array were obtained, and clear fundamental mode Rayleigh waves were observed between 2.5 and 5 s periods. In addition, higher-mode signals were observed around 2 s period. Frequency-time analysis was applied to measure fundamental mode Rayleigh wave phase velocities, which were used to invert for 2-D phase velocity maps. An azimuth-dependent traveltime correction was implemented to mitigate potential biases introduced due to an inhomogeneous noise source distribution. Reliable phase velocity maps were only obtained between 3 and 4 s periods due to limitations imposed by the array aperture and higher-mode contamination. The phase velocity tomography results, which are sensitive to structure shallower than 6 km depth, reveal an ~10–15% low-velocity anomaly centered beneath the volcanic edifice and peripheral high-velocity anomalies that likely correspond to cooled igneous intrusions. We suggest that the low-velocity anomaly reflects the high-porosity mixture of lava and ash deposits near the surface of the edifice, a highly fractured magmatic conduit and hydrothermal system beneath the volcano, and possibly a small contribution from silicate melt.

An update on clinical oncology for the non-oncologist.

Science.gov (United States)

Kaliks, Rafael Aliosha

2016-01-01

ABSTRACTRecent advances in the understanding of tumor driver mutations, signaling pathways that lead to tumor progression, and the better understanding of the interaction between tumor cells and the immune system are revolutionizing cancer treatment. The pace at which new treatments are approved and the prices at which they are set have made it even more difficult to offer these treatments in countries like Brazil. In this review we present for the non-oncologist these new treatments and compare their availability in Brazilian public health system and private health system with that of developed countries.RESUMOAvanços recentes na compreensão de mutações promotoras de desenvolvimento do câncer, sinalização que leva à progressão de tumores, e o avanço no entendimento da interação entre as células tumorais e o sistema imunológico estão revolucionando o tratamento do câncer. A velocidade com que novos tratamentos são aprovados e o alto custo das medicações dificultam a disponibilização de terapêuticas em países como o Brasil. Nesta revisão, apresentamos ao não oncologista esses novos tratamentos e comparamos sua disponibilidade nos sistemas público e privado de saúde no Brasil com os países desenvolvidos.

Evidence for degassing of fresh magma during the 2004-2008 eruption of Mount St. Helens: Subtle signals from the hydrothermal system

Science.gov (United States)

Bergfeld, Deborah; Evans, William C.; Spicer, Kurt R.; Hunt, Andrew G.; Kelly, Peter

2017-01-01

Results from chemical and isotopic analyses of water and gas collected between 2002 and 2016 from sites on and around Mount St. Helens are used to assess magmatic degassing related to the 2004-2008 eruption. During 2005 the chemistry of hot springs in The Breach of Mount St. Helens showed no obvious response to the eruption, and over the next few years, changes were subtle, giving only slight indications of perturbations in the system. By 2010 however, water chemistry, temperatures, and isotope compositions (δD and δ18O) clearly indicated some inputs of volatiles and heat associated with the eruption, but the changes were such that they could be attributed to a pre-existing, gas depleted magma. An increase of ~ 1.5‰ in the δ13C values of dissolved carbon in the springs was noted in 2006 and continued through 2009, a change that was mirrored by a similar shift in δ13C-CO2 in bubble gas emissions. These changes require input of a new source of carbon to the hydrothermal system and provide clear evidence of CO2 from an undegassed body of magma. Rising trends in 3He/4He ratios in gas also accompanied the increases in δ13C. Since 2011 maximum RC/RA values are ≥ 6.4 and are distinctly higher than 5 samples collected between 1986 and 2002, and provide additional evidence for some involvement of new magma as early as 2006, and possibly earlier, given the unknown time needed for CO2 and He to traverse the system and arrive at the springs.

Long-term autonomous volcanic gas monitoring with Multi-GAS at Mount St. Helens, Washington, and Augustine Volcano, Alaska

Science.gov (United States)

Kelly, P. J.; Ketner, D. M.; Kern, C.; Lahusen, R. G.; Lockett, C.; Parker, T.; Paskievitch, J.; Pauk, B.; Rinehart, A.; Werner, C. A.

2015-12-01

In recent years, the USGS Volcano Hazards Program has worked to implement continuous real-time in situ volcanic gas monitoring at volcanoes in the Cascade Range and Alaska. The main goal of this ongoing effort is to better link the compositions of volcanic gases to other real-time monitoring data, such as seismicity and deformation, in order to improve baseline monitoring and early detection of volcanic unrest. Due to the remote and difficult-to-access nature of volcanic-gas monitoring sites in the Cascades and Alaska, we developed Multi-GAS instruments that can operate unattended for long periods of time with minimal direct maintenance from field personnel. Our Multi-GAS stations measure H2O, CO2, SO2, and H2S gas concentrations, are comprised entirely of commercial off-the-shelf components, and are powered by small solar energy systems. One notable feature of our Multi-GAS stations is that they include a unique capability to perform automated CO2, SO2, and H2S sensor verifications using portable gas standards while deployed in the field, thereby allowing for rigorous tracking of sensor performances. In addition, we have developed novel onboard data-processing routines that allow diagnostic and monitoring data - including gas ratios (e.g. CO2/SO2) - to be streamed in real time to internal observatory and public web pages without user input. Here we present over one year of continuous data from a permanent Multi-GAS station installed in August 2014 in the crater of Mount St. Helens, Washington, and several months of data from a station installed near the summit of Augustine Volcano, Alaska in June 2015. Data from the Mount St. Helens Multi-GAS station has been streaming to a public USGS site since early 2015, a first for a permanent Multi-GAS site. Neither station has detected significant changes in gas concentrations or compositions since they were installed, consistent with low levels of seismicity and deformation.

Low Interrater Reliability in Grading of Rectal Bleeding Using National Cancer Institute Common Toxicity Criteria and Radiation Therapy Oncology Group Toxicity Scales: A Survey of Radiation Oncologists

International Nuclear Information System (INIS)

Huynh-Le, Minh-Phuong; Zhang, Zhe; Tran, Phuoc T.; DeWeese, Theodore L.; Song, Daniel Y.

2014-01-01

Purpose: To measure concordance among genitourinary radiation oncologists in using the National Cancer Institute Common Toxicity Criteria (NCI CTC) and Radiation Therapy Oncology Group (RTOG) grading scales to grade rectal bleeding. Methods and Materials: From June 2013 to January 2014, a Web-based survey was sent to 250 American and Canadian academic radiation oncologists who treat prostate cancer. Participants were provided 4 case vignettes in which patients received radiation therapy and developed rectal bleeding and were asked for management plans and to rate the bleeding according to NCI CTC v.4 and RTOG late toxicity grading (scales provided). In 2 cases, participants were also asked whether they would send the patient for colonoscopy. A multilevel, random intercept modeling approach was used to assess sources of variation (case, respondent) in toxicity grading to calculate the intraclass correlation coefficient (ICC). Agreement on a dichotomous grading scale (low grades 1-2 vs high grades 3-4) was also assessed, using the κ statistic for multiple respondents. Results: Seventy-two radiation oncologists (28%) completed the survey. Forty-seven (65%) reported having either written or been principal investigator on a study using these scales. Agreement between respondents was moderate (ICC 0.52, 95% confidence interval [CI] 0.47-0.58) when using NCI CTC and fair using the RTOG scale (ICC 0.28, 95% CI 0.20-0.40). Respondents who chose an invasive management were more likely to select a higher toxicity grade (P<.0001). Using the dichotomous scale, we observed moderate agreement (κ = 0.42, 95% CI 0.40-0.44) with the NCI CTC scale, but only slight agreement with the RTOG scale (κ = 0.19, 95% CI 0.17-0.21). Conclusion: Low interrater reliability was observed among radiation oncologists grading rectal bleeding using 2 common scales. Clearer definitions of late rectal bleeding toxicity should be constructed to reduce this variability and avoid ambiguity in both

Strategies for the Management of Localized Prostate Cancer: A Guide for Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

NONE

2014-09-15

Prostate cancer is a serious health issue, especially considering the recent epidemiological trend and its corresponding socioeconomic impact. Challenges encountered by treating physicians include the long natural history of the disease, the fact that it is more prevalent in the elderly and the difficulty in performing a complete critical review of medical evidence due to the plethora of available information. In addition, the difficulty in deciding if and when therapeutic intervention should be initiated is an important issue pertaining to this type of malignancy. However, there is one area where there is a uniform consensus: the applicability of the multidisciplinary approach in the management of prostate cancer. Clinical guidelines are systematically developed statements designed to help practitioners, managers and patients make decisions about appropriate health care for specific circumstances. Clinicians need simple, patient specific, user friendly guidelines. The main purposes of clinical guidelines are to: (a) provide recommendations for the treatment of individual patients by practitioners; (b) help develop standards to assess the individual practice of health professionals; (c) be used in the education and training of health professionals; (d) assist patients in making informed decisions; and (e) improve communication between patients and health professionals. Clinical guidelines for the management of prostate cancer exist in the published literature. However, these guidelines have usually been developed in and for affluent health care environments where all modern diagnostic and treatment modalities are available. In limited resource environments, the radiation oncologist is faced with the question of what the minimum acceptable (evidence based) line of action would be, considering the limited resources available. Clinical guidelines focusing on low to middle income countries aim to provide these practitioners with a practical tool. This publication is

Strategies for the Management of Localized Prostate Cancer: A Guide for Radiation Oncologists

International Nuclear Information System (INIS)

2014-01-01

Prostate cancer is a serious health issue, especially considering the recent epidemiological trend and its corresponding socioeconomic impact. Challenges encountered by treating physicians include the long natural history of the disease, the fact that it is more prevalent in the elderly and the difficulty in performing a complete critical review of medical evidence due to the plethora of available information. In addition, the difficulty in deciding if and when therapeutic intervention should be initiated is an important issue pertaining to this type of malignancy. However, there is one area where there is a uniform consensus: the applicability of the multidisciplinary approach in the management of prostate cancer. Clinical guidelines are systematically developed statements designed to help practitioners, managers and patients make decisions about appropriate health care for specific circumstances. Clinicians need simple, patient specific, user friendly guidelines. The main purposes of clinical guidelines are to: (a) provide recommendations for the treatment of individual patients by practitioners; (b) help develop standards to assess the individual practice of health professionals; (c) be used in the education and training of health professionals; (d) assist patients in making informed decisions; and (e) improve communication between patients and health professionals. Clinical guidelines for the management of prostate cancer exist in the published literature. However, these guidelines have usually been developed in and for affluent health care environments where all modern diagnostic and treatment modalities are available. In limited resource environments, the radiation oncologist is faced with the question of what the minimum acceptable (evidence based) line of action would be, considering the limited resources available. Clinical guidelines focusing on low to middle income countries aim to provide these practitioners with a practical tool. This publication is

Contemporary management of prostate cancer: a practice survey of Ontario genitourinary radiation oncologists

International Nuclear Information System (INIS)

Rodrigues, George; D'Souza, David; Crook, Juanita; Malone, Shawn; Sathya, Jinka; Morton, Gerard

2003-01-01

Objective: To survey radiation oncology practice in the utilization of hormonal and radiation therapy in the primary, adjuvant and salvage treatment of localized prostate cancer. Materials and methods: Genitourinary radiation oncologists practicing in Ontario were invited to participate in a practice survey examining staging, hormonal and radiation management, and radiation technique for a variety of common clinical scenarios. Background demographic information was collected on all respondents. The survey consisted of three cases relating to the hormonal/radiation management of low-, intermediate-, and high-risk prostate cancer as well as two adjuvant and one salvage post-prostatectomy scenarios. The survey response rate was 70% (26/37). Results: Clinicians were more likely to utilize laboratory and imaging studies for staging as the risk categorization increased. Low-risk disease was managed with radiation alone in 26/26 (70 Gy in 65%, 74-79.8 Gy in 35%). Intermediate-risk disease was managed with radiation (70 Gy in 46%, 74-79.8 Gy in 54%) with neoadjuvant hormones in 58%. All respondents managed high-risk disease with adjuvant hormones in addition to radiation therapy (70-71 Gy in 85%, and 76 Gy in 15%). In the pT3a, margin negative (PSA undetectable) scenario, most individuals would not recommend adjuvant radiation (73%). If margins were positive, 30% would still not recommend adjuvant radiation. In the salvage scenario (slowly rising PSA 4 years post-prostatectomy for pT2a close margin disease), all respondents would manage with radiation therapy. Hormones were not routinely recommended in the initial management of the adjuvant and salvage scenarios. Radiation doses utilized for both adjuvant and salvage treatment ranged from 60-70 Gy (median 66 Gy). Conclusions: General agreement exists for the management of low- and high-risk disease and in the post-prostatectomy salvage setting. Use of dose-escalation and neoadjuvant hormones in the intermediate

Amphibole trace elements as indicators of magmatic processes at Mount St. Helens

Science.gov (United States)

Hampel, T. R.; Rowe, M. C.; Kent, A.; Thornber, C. R.

2011-12-01

Amphibole has the capability of incorporating a wide variety of trace elements resulting from a range of magmatic processes. Prior studies have used trace elements such as Li and Cu in amphibole to investigate volatile mobility associated with magma ascent regarding the 2004-2008 eruption of Mount St. Helens (Rowe et al. 2008). In order to investigate magmatic processes associated with the 2004-2008 eruption of Mount St. Helens we have measured a range of fluid-mobile trace elements in conjunction with major element compositions of amphibole phenocrysts in dacite lava. Major elements and volatiles (Cl, F) were measured by electron microprobe analysis at Washington State University and trace elements (Li, Sc, Co, Cu, Zn, Sr, Y, Zr, Mo, Ag, Sn, Sb, Te, Ba, Ce, W, and Pb) were analyzed by laser ablation (LA)-ICP-MS at Oregon State University. Amphibole crystallization temperatures were calculated after Ridolfi et al. (2010). Core to rim transects were measured by electron microprobe to evaluate volatile concentrations and temperature profiles across individual phenocrysts. Core temperatures from 17 days and 226 days post eruption are consistently hotter than the rim temperatures 997 to 881 degrees C, respectively. Amphiboles from the end of the eruption (811 days post eruption) appear to be more complex, with phenocrysts having both increasing and decreasing temperatures toward the rims. The overall calculated temperature range of the amphiboles at the end of the eruption is 1022 to 919 degrees C. There is much diversity in the concentrations of Li and Cu within the phenocrysts in both the samples and throughout the eruption. Concentrations steadily increase in the beginning of the eruption then drop dramatically toward the middle, slowly increase toward the end eruption. Overall concentrations of Sr, Sb, Co, Sn, Mo, Ba, Ce, Sc, and Y do not change over the course of the eruption but do vary sample to sample. Preliminary data for Zn, Sb, Ag, and W suggest the

Faulting within the Mount St. Helens conduit and implications for volcanic earthquakes

Science.gov (United States)

Pallister, John S.; Cashman, Katharine V.; Hagstrum, Jonathan T.; Beeler, Nicholas M.; Moran, Seth C.; Denlinger, Roger P.

2013-01-01

The 2004–2008 eruption of Mount St. Helens produced seven dacite spines mantled by cataclastic fault rocks, comprising an outer fault core and an inner damage zone. These fault rocks provide remarkable insights into the mechanical processes that accompany extrusion of degassed magma, insights that are useful in forecasting dome-forming eruptions. The outermost part of the fault core consists of finely comminuted fault gouge that is host to 1- to 3-mm-thick layers of extremely fine-grained slickenside-bearing ultracataclasite. Interior to the fault core, there is an ∼2-m-thick damage zone composed of cataclastic breccia and sheared dacite, and interior to the damage zone, there is massive to flow-banded dacite lava of the spine interior. Structures and microtextures indicate entirely brittle deformation, including rock breakage, tensional dilation, shearing, grain flow, and microfaulting, as well as gas and fluid migration through intergranular pores and fractures in the damage zone. Slickenside lineations and consistent orientations of Riedel shears indicate upward shear of the extruding spines against adjacent conduit wall rocks.Paleomagnetic directions, demagnetization paths, oxide mineralogy, and petrology indicate that cataclasis took place within dacite in a solidified steeply dipping volcanic conduit at temperatures above 500 °C. Low water content of matrix glass is consistent with brittle behavior at these relatively high temperatures, and the presence of tridymite indicates solidification depths of <1 km. Cataclasis was coincident with the eruption’s seismogenic zone at <1.5 km.More than a million small and low-frequency “drumbeat” earthquakes with coda magnitudes (Md) <2.0 and frequencies <5 Hz occurred during the 2004–2008 eruption. Our field data provide a means with which to estimate slip-patch dimensions for shear planes and to compare these with estimates of slip patches based on seismic moments and shear moduli for dacite rock and

The role of ASTRO and the radiation oncologist in preparedness

International Nuclear Information System (INIS)

Daly, N.

2003-01-01

The events on September 11, 2001 were unpredictable and tragic, however it is not inconceivable that a similar terrorist event could occur again, this time involving radiologic or nuclear material. In order to prepare for this American Society for Therapeutic Radiology and Oncology (ASTRO) convened a task force. Initially the task force worked with the American College of Radiology (ACR)and the American Society of Physicists in Medicine (AAPM)to publish a PRIMER entitled 'Disaster Preparedness for Radiology Professionals'. The PRIMER serve as a quick reference in the event of a radiation disaster and is available on the ASTRO Web site (www.astro.org). The task force has also developed a detailed and extensive training program, in partnership with the U.S. Department of Energy's Radiation Emergency Assistance Center/Training Site (REAC/TS) in Oak Ridge (TN), that will equip radiation oncologists with the necessary expertise to train hospital radiation oncology departments and other healthcare personnel who are responsible for implementing and carrying out hospital planning for disasters involving radioactive materials. This presentation will outline the effort ASTRO has been involved with since September 11, 2001 to prepare the professional community it represent in the event of a radiation/nuclear disaster

Correlates of oncologist-issued referrals for psycho-oncology services: what we learned from the electronic voluntary screening and referral system for depression (eVSRS-D).

Science.gov (United States)

Lee, Joo-Young; Jung, Dooyoung; Kim, Won-Hyoung; Lee, Hyuk-Joon; Noh, Dong-Young; Hahm, Bong-Jin

2016-02-01

Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS). The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups. Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions. The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals. Copyright © 2015 John Wiley & Sons, Ltd.

Constraining the Magmatic System at Mount St. Helens (2004-2008) Using Bayesian Inversion With Physics-Based Models Including Gas Escape and Crystallization

International Nuclear Information System (INIS)

Wong, Ying-Qi; Segall, Paul; Bradley, Andrew; Anderson, Kyle

2017-01-01

Physics-based models of volcanic eruptions track conduit processes as functions of depth and time. When used in inversions, these models permit integration of diverse geological and geophysical data sets to constrain important parameters of magmatic systems. We develop a 1-D steady state conduit model for effusive eruptions including equilibrium crystallization and gas transport through the conduit and compare with the quasi-steady dome growth phase of Mount St. Helens in 2005. Viscosity increase resulting from pressure-dependent crystallization leads to a natural transition from viscous flow to frictional sliding on the conduit margin. Erupted mass flux depends strongly on wall rock and magma permeabilities due to their impact on magma density. Including both lateral and vertical gas transport reveals competing effects that produce nonmonotonic behavior in the mass flux when increasing magma permeability. Using this physics-based model in a Bayesian inversion, we link data sets from Mount St. Helens such as extrusion flux and earthquake depths with petrological data to estimate unknown model parameters, including magma chamber pressure and water content, magma permeability constants, conduit radius, and friction along the conduit walls. Even with this relatively simple model and limited data, we obtain improved constraints on important model parameters. We find that the magma chamber had low (<5 wt %) total volatiles and that the magma permeability scale is well constrained at ~10 –11.4 m 2 to reproduce observed dome rock porosities. Here, compared with previous results, higher magma overpressure and lower wall friction are required to compensate for increased viscous resistance while keeping extrusion rate at the observed value.

Observer variation in target volume delineation of lung cancer related to radiation oncologist-computer interaction: A 'Big Brother' evaluation

International Nuclear Information System (INIS)

Steenbakkers, Roel J.H.M.; Duppen, Joop C.; Fitton, Isabelle; Deurloo, Kirsten E.I.; Zijp, Lambert; Uitterhoeve, Apollonia L.J.; Rodrigus, Patrick T.R.; Kramer, Gijsbert W.P.; Bussink, Johan; Jaeger, Katrien De; Belderbos, Jose S.A.; Hart, Augustinus A.M.; Nowak, Peter J.C.M.; Herk, Marcel van; Rasch, Coen R.N.

2005-01-01

Background and purpose: To evaluate the process of target volume delineation in lung cancer for optimization of imaging, delineation protocol and delineation software. Patients and methods: Eleven radiation oncologists (observers) from five different institutions delineated the Gross Tumor Volume (GTV) including positive lymph nodes of 22 lung cancer patients (stages I-IIIB) on CT only. All radiation oncologist-computer interactions were recorded with a tool called 'Big Brother'. For each radiation oncologist and patient the following issues were analyzed: delineation time, number of delineated points and corrections, zoom levels, level and window (L/W) settings, CT slice changes, use of side windows (coronal and sagittal) and software button use. Results: The mean delineation time per GTV was 16 min (SD 10 min). The mean delineation time for lymph node positive patients was on average 3 min larger (P=0.02) than for lymph node negative patients. Many corrections (55%) were due to L/W change (e.g. delineating in mediastinum L/W and then correcting in lung L/W). For the lymph node region, a relatively large number of corrections was found (3.7 corr/cm 2 ), indicating that it was difficult to delineate lymph nodes. For the tumor-atelectasis region, a relative small number of corrections was found (1.0 corr/cm 2 ), indicating that including or excluding atelectasis into the GTV was a clinical decision. Inappropriate use of L/W settings was frequently found (e.g. 46% of all delineated points in the tumor-lung region were delineated in mediastinum L/W settings). Despite a large observer variation in cranial and caudal direction of 0.72 cm (1 SD), the coronal and sagittal side windows were not used in 45 and 60% of the cases, respectively. For the more difficult cases, observer variation was smaller when the coronal and sagittal side windows were used. Conclusions: With the 'Big Brother' tool a method was developed to trace the delineation process. The differences between

Perceptions of Oncologists, Healthcare Policy Makers, Patients and the General Population on the Value of Pharmaceutical Treatments in Oncology.

Science.gov (United States)

Sacristán, José A; Lizan, Luís; Comellas, Marta; Garrido, Pilar; Avendaño, Cristina; Cruz-Hernández, Juan J; Espinosa, Javier; Dilla, Tatiana

2016-11-01

The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients' individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. Eli Lilly & Co, Madrid (Spain).

Where is the hot rock and where is the ground water – Using CSAMT to map beneath and around Mount St. Helens

Science.gov (United States)

Wynn, Jeff; Mosbrucker, Adam; Pierce, Herbert; Spicer, Kurt R.

2016-01-01

We have observed several new features in recent controlled-source audio-frequency magnetotelluric (CSAMT) soundings on and around Mount St. Helens, Washington State, USA. We have identified the approximate location of a strong electrical conductor at the edges of and beneath the 2004–08 dome. We interpret this conductor to be hot brine at the hot-intrusive-cold-rock interface. This contact can be found within 50 meters of the receiver station on Spine 5, which extruded between April and July of 2005. We have also mapped separate regional and glacier-dome aquifers, which lie one atop the other, out to considerable distances from the volcano.

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

Science.gov (United States)

Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

2014-01-01

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

Field-trip guide to Mount St. Helens, Washington - An overview of the eruptive history and petrology, tephra deposits, 1980 pyroclastic density current deposits, and the crater

Science.gov (United States)

Pallister, John S.; Clynne, Michael A.; Wright, Heather M.; Van Eaton, Alexa R.; Vallance, James W.; Sherrod, David R.; Kokelaar, B. Peter

2017-08-02

This field trip will provide an introduction to several fascinating features of Mount St. Helens. The trip begins with a rigorous hike of about 15 km from the Johnston Ridge Observatory (9 km north-northeast of the crater vent), across the 1980 Pumice Plain, to Windy Ridge (3.6 km northeast of the crater vent) to examine features that document the dynamics and progressive emplacement of pyroclastic flows. The next day, we examine classic tephra outcrops of the past 3,900 years and observe changes in thickness and character of these deposits as we traverse their respective lobes. We examine clasts in the deposits and discuss how the petrology and geochemistry of Mount St. Helens deposits reveal the evolution of the magmatic system through time. We also investigate the stratigraphy of the 1980 blast deposit and review the chronology of this iconic eruption as we travel through the remains of the blown-down forest. The third day is another rigorous hike, about 13 km round trip, climbing from the base of Windy Ridge (elevation 1,240 m) to the front of the Crater Glacier (elevation 1,700 m). En route we examine basaltic andesite and basalt lava flows emplaced between 1,800 and 1,700 years before present, a heterolithologic flow deposit produced as the 1980 blast and debris avalanche interacted, debris-avalanche hummocks that are stranded on the north flank and in the crater mouth, and shattered dacite lava domes that were emplaced between 3,900 and 2,600 years before present. These domes underlie the northern part of the volcano. In addition, within the crater we traverse well-preserved pyroclastic-flow deposits that were emplaced on the crater floor during the summer of 1980, and a beautiful natural section through the 1980 deposits in the upper canyon of the Loowit River.Before plunging into the field-trip log, we provide an overview of Mount St. Helens geology, geochemistry, petrology, and volcanology as background. The volcano has been referred to as a �

Overcoming communication challenges in integrative supportive cancer care: The integrative physician, the psycho-oncologist, and the patient.

Science.gov (United States)

Ben-Arye, Eran; Shavit, Efrat; Wiental, Haya; Schiff, Elad; Agour, Olga; Samuels, Noah

2016-12-01

Complementary/integrative medicine (CIM) services are increasingly being integrated into conventional supportive cancer care, presenting a number of challenges to communication between healthcare professionals (HCPs). The purpose of the present study was to explore the impact of the communication between integrative physicians (IPs) trained in CIM and social workers (SWs) working as psycho-oncologists in the same oncology setting. We examine whether IP-SW communication correlates with the number of patient-SW sessions, as provided within the oncology department. SW-IP communication, defined as a summary of the IP consultation sent to the patient's SW, was compared to SW-patient communication, defined as the number of psycho-oncology treatment sessions. Of 344 patients referred by their oncology HCP for IP consultation, 91 were referred by an SW and 253 by an oncologist or nurse. IP-to-SW summaries were provided for 150 patients referred by a non-SW HCP (43.6%), and for 91 of SW-referred patients (26.5%). In all, 32 patients referred to the IP had no psycho-oncology interaction with an SW; 58 only one meeting; and 254 with ≥2 interactions, with 119 having >6 sessions. SW-patient interactions were greater with higher rates of IP-SW communication, for both patients referred by an SW (79.1%) and those referred by a non-SW HCP (77.3%) when compared to patients for whom no summary was provided (64.1%; p= 0.02). A greater level of IP-SW communication, measured by the provision of an IP summary to the patient's SW, was found to correlate with a higher rate of SW-patient interactions. The use of a structured two-way referral-summary between IPs and SWs has the potential to advance the SW-patient psycho-oncology interaction, within an integrative supportive cancer care setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

Directory of Open Access Journals (Sweden)

Sjoerd Kolk

2014-01-01

Full Text Available Accurate predictions of functional outcome after limb salvage surgery (LSS in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS and the RAND-36 physical functioning subscale (RAND-36 PFS. The orthopedic oncologists made their predictions based on case descriptions (including MRI scans that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2 values ranged from 0.014 to 0.354. Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons’ ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO)

International Nuclear Information System (INIS)

2009-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

A semiautomatic CT-based ensemble segmentation of lung tumors: comparison with oncologists' delineations and with the surgical specimen.

Science.gov (United States)

Rios Velazquez, Emmanuel; Aerts, Hugo J W L; Gu, Yuhua; Goldgof, Dmitry B; De Ruysscher, Dirk; Dekker, Andre; Korn, René; Gillies, Robert J; Lambin, Philippe

2012-11-01

To assess the clinical relevance of a semiautomatic CT-based ensemble segmentation method, by comparing it to pathology and to CT/PET manual delineations by five independent radiation oncologists in non-small cell lung cancer (NSCLC). For 20 NSCLC patients (stages Ib-IIIb) the primary tumor was delineated manually on CT/PET scans by five independent radiation oncologists and segmented using a CT based semi-automatic tool. Tumor volume and overlap fractions between manual and semiautomatic-segmented volumes were compared. All measurements were correlated with the maximal diameter on macroscopic examination of the surgical specimen. Imaging data are available on www.cancerdata.org. High overlap fractions were observed between the semi-automatically segmented volumes and the intersection (92.5±9.0, mean±SD) and union (94.2±6.8) of the manual delineations. No statistically significant differences in tumor volume were observed between the semiautomatic segmentation (71.4±83.2 cm(3), mean±SD) and manual delineations (81.9±94.1 cm(3); p=0.57). The maximal tumor diameter of the semiautomatic-segmented tumor correlated strongly with the macroscopic diameter of the primary tumor (r=0.96). Semiautomatic segmentation of the primary tumor on CT demonstrated high agreement with CT/PET manual delineations and strongly correlated with the macroscopic diameter considered as the "gold standard". This method may be used routinely in clinical practice and could be employed as a starting point for treatment planning, target definition in multi-center clinical trials or for high throughput data mining research. This method is particularly suitable for peripherally located tumors. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

From will to live to will to die: oncologists, nurses, and social workers identification of suicidality in cancer patients.

Science.gov (United States)

Granek, Leeat; Nakash, Ora; Ariad, Samuel; Chen, Wendy; Birenstock-Cohen, Shira; Shapira, Shahar; Ben-David, Merav

2017-12-01

The purpose of this research was to examine how oncologists, nurses, and social workers identify suicidality in cancer patients. Sixty-one healthcare professionals (23 oncologists, 18 social workers, and 20 nurses) at two academic cancer centers were interviewed using an in-depth interview guide. This was a qualitative study based on grounded theory methodology. Analysis involved line-by-line coding, with categories and themes emerging from participants' narratives. Suicidality in cancer patients exists on a wide spectrum that ranges from an active will to live to an active will to die. Four phases were identified that included: (A) a strong will to live expressed in themes of active treatments, seeking second opinions, overtreatment, and alternative treatments; (B) a decreasing will to live indicated in themes of mental health distress and physical pain and suffering; (C) a readiness to die expressed in themes of mental health distress, previous mental health diagnoses, physical pain, avoiding more suffering, preserving quality of life in old age, nearing end of life, lack of social support, and maintaining a sense of control; and (D) a will to die indicated in themes of euthanasia and active suicidality. Suicidality in cancer patients exists on a continuum. Cancer patients fluctuate on this spectrum depending on circumstances such as degree of suffering, their personalities and life circumstances, and whether they are nearing the end of life. Results of the study emphasize the need to collect more context specific data on suicidality among cancer patients and the importance of early integration of psychosocial and palliative care in the cancer treatment trajectory.

Conduit degassing and thermal controls on eruption styles at Mount St. Helens

Science.gov (United States)

Schneider, Andrew; Rempel, Alan W.; Cashman, Katharine V.

2012-12-01

The explosivity of silicic eruptions depends on the interplay between magma rheology, exsolution kinetics, and degassing. Magma degassing is governed by the competing effects of vertical transport within the conduit and the lateral flux of gas out of the conduit (Diller et al., 2006; Jaupart and Allegre, 1991). We combine a simplified treatment of these degassing processes with thermodynamic modeling to examine the conditions present at Mount St. Helens during the spine extruding eruption from 2004 to 2008. We find that two parameters are primarily responsible for controlling the eruptive style: the magma chamber temperature, and a dimensionless parameter that gauges the efficiency of lateral degassing. Together, these parameters determine whether and where magma can solidify at depth to form a dense solid plug that is gradually extruded as a volcanic spine. We show that the small (50 oC) decrease in magma chamber temperature between eruptive activity in the 1980s and that of 2004-2008, combined with a modest increase in degassing efficiency associated with lower volumetric flux, can explain the observed change in erupted material from viscous lava flows to solidified spines. More generally, we suggest that similar threshold behavior may explain observed abrupt transitions in effusive eruptive styles at other intermediate composition volcanoes. Finally, we extrapolate our results to suggest that the increase in degassing efficiency accompanying decreasing magma supply rates may have caused the transition from explosive to effusive activity in late 1980.

Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer.

Science.gov (United States)

Blum, David; Rosa, Daniel; deWolf-Linder, Susanne; Hayoz, Stefanie; Ribi, Karin; Koeberle, Dieter; Strasser, Florian

2014-12-01

Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer. The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts. First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions. Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch. Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization. Copyright © 2014 American Academy of Hospice and

Education and Outreach through Ludo-Pedagogy and Experiential Learning. Bridging Feminist and Diversity Movements in Today's Nicaragua: An Interview with Helen Alfaro, Yova Briones, and Tannia Rizo Lazo of La Casa de los Colores

Science.gov (United States)

DeGrave, Analisa

2016-01-01

La Casa de los Colores (the House of Colors) is a feminist organization dedicated to defending human rights, particularly those of the LGBTQ+ community in León, Nicaragua. In 2016 Helen Alfaro, Yova Briones, Ani Guerrero, and Tannia Rizo Lazo, four members of La Casa's leadership team, "Las Coloras," were invited to speak about…

Reading, Trauma and Literary Caregiving 1914-1918: Helen Mary Gaskell and the War Library.

Science.gov (United States)

Haslam, Sara

2018-03-28

This article is about the relationship between reading, trauma and responsive literary caregiving in Britain during the First World War. Its analysis of two little-known documents describing the history of the War Library, begun by Helen Mary Gaskell in 1914, exposes a gap in the scholarship of war-time reading; generates a new narrative of "how," "when," and "why" books went to war; and foregrounds gender in its analysis of the historiography. The Library of Congress's T. W. Koch discovered Gaskell's ground-breaking work in 1917 and reported its successes to the American Library Association. The British Times also covered Gaskell's library, yet researchers working on reading during the war have routinely neglected her distinct model and method, skewing the research base on war-time reading and its association with trauma and caregiving. In the article's second half, a literary case study of a popular war novel demonstrates the extent of the "bitter cry for books." The success of Gaskell's intervention is examined alongside H. G. Wells's representation of textual healing. Reading is shown to offer sick, traumatized and recovering combatants emotional and psychological caregiving in ways that she could not always have predicted and that are not visible in the literary/historical record.

Managing a national radiation oncologist workforce: A workforce planning model

International Nuclear Information System (INIS)

Stuckless, Teri; Milosevic, Michael; Metz, Catherine de; Parliament, Matthew; Tompkins, Brent; Brundage, Michael

2012-01-01

Purpose: The specialty of radiation oncology has experienced significant workforce planning challenges in many countries. Our purpose was to develop and validate a workforce-planning model that would forecast the balance between supply of, and demand for, radiation oncologists in Canada over a minimum 10-year time frame, to identify the model parameters that most influenced this balance, and to suggest how this model may be applicable to other countries. Methods: A forward calculation model was created and populated with data obtained from national sources. Validation was confirmed using a historical prospective approach. Results: Under baseline assumptions, the model predicts a short-term surplus of RO trainees followed by a projected deficit in 2020. Sensitivity analyses showed that access to radiotherapy (proportion of incident cases referred), individual RO workload, average age of retirement and resident training intake most influenced balance of supply and demand. Within plausible ranges of these parameters, substantial shortages or excess of graduates is possible, underscoring the need for ongoing monitoring. Conclusions: Workforce planning in radiation oncology is possible using a projection calculation model based on current system characteristics and modifiable parameters that influence projections. The workload projections should inform policy decision making regarding growth of the specialty and training program resident intake required to meet oncology health services needs. The methods used are applicable to workforce planning for radiation oncology in other countries and for other comparable medical specialties.

Isotopic insights into the degassing and secondary hydration of volcanic glass from the 1980 eruptions of Mount St. Helens

Science.gov (United States)

Seligman, Angela N.; Bindeman, Ilya; Van Eaton, Alexa; Hoblitt, Richard

2018-04-01

Abstract The magmatic degassing history of newly erupted volcanic glass is recorded in its remaining volatile content. However, this history is subsequently overprinted by post-depositional (secondary) hydration, the rates and origins of which are not yet adequately constrained. Here, we present the results of a natural experiment using products of the 1980 eruptions of Mount St. Helens. We measured water concentration, δDglass, and δ18OBSG (δ18O of the bulk silicate glass) of samples collected during the dry summer months of 1980 and compared them with material resampled in 2015 from the same deposits. Samples collected from the subsurface near gas escape pipes show elevated water concentrations (near 2.0 wt%), and these are associated with lower δDglass (- 110 to - 130‰) and δ18OBSG (6.0 to 6.6‰) values than the 1980 glass (- 70 to - 100‰ and 6.8 to 6.9‰, respectively). Samples collected in 2015 from the surface to 10-cm subsurface of the 1980 summer deposits have a small increase in average water contents of 0.1-0.2 wt% but similar δ18OBSG (6.8-6.9‰) values compared to the 1980 glass values. These samples, however, show 15‰ higher δDglass values; exchange with meteoric water is expected to yield lower δDglass values. We attribute higher δDglass values in the upper portion of the 1980 deposits collected in 2015 to rehydration by higher δD waters that were degassed for several months to a year from the hot underlying deposits, which hydrated the overlying deposits with relatively high δD gases. Our data also contribute to magmatic degassing of crystal-rich volcanoes. Using the 1980 samples, our reconstructed δD-H2O trends for the dacitic Mount St. Helens deposits with rhyolitic groundmass yield a trend that overlaps with the degassing trend for crystal-poor rhyolitic eruptions studied previously elsewhere, suggesting similar behavior of volatiles upon exsolution from magma. Furthermore, our data support previous studies proposing that

Dreams, themes and particle beams--an oncologist's perspective on technology trickle-down from the LHC.

Science.gov (United States)

Jena, R

2014-04-01

11 years ago, the European Network for Light Ion Therapy (ENLIGHT) was established as a multidisciplinary network of engineers, physicists and clinicians with a common interest in the development of hadron therapy in Europe. ENLIGHT is coordinated from the European Centre for Nuclear Research (CERN), the home of the Large Hadron Collider. The network has evolved into a mature platform for research, with more than 100 researchers working in CERN and its allied research centres. One of the benefits of hosting this network at CERN is the ability to translate hardware and software developments, originally developed in the High Energy Physics domain, into clinical applications. From the perspective of a clinical radiation oncologist within the network, this commentary reviews the ways in which leading edge technological developments in detectors and solid state physics, Monte-Carlo simulation, grid computing and accelerator design have trickled down into real-world clinical applications.

The past, present, and future of paediatric cardiology training at the Johns Hopkins Hospital, in the tradition of Dr Helen Taussig.

Science.gov (United States)

Beasley, Gary S; Murphy, Anne M; Brenner, Joel I; Ravekes, William J

2016-12-01

Johns Hopkins has been a leader in paediatric cardiology for over 85 years. In the 1940s, Dr Helen Taussig began training fellows in paediatric cardiology at Johns Hopkins at a time when the diagnosis and treatment of CHD were in the earliest stage. Under her leadership, the fellowship developed a strong foundation that has continued to evolve to meet the current needs of learners and educators. In the current era, the Johns Hopkins programme implements the current theories of adult education and actively engages our fellows in learning as well as teaching. The programme uses techniques such as flipped classroom, structured case-based small-group learning, observed and structured clinical examination, simulations, and innovative educational technology. These strategies combined with our faculty and rich history give our fellows a unique educational experience.

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (Chinese Edition)

International Nuclear Information System (INIS)

2014-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths … worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (French Edition)

International Nuclear Information System (INIS)

2013-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (Spanish Edition)

International Nuclear Information System (INIS)

2014-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (Russian Edition)

International Nuclear Information System (INIS)

2014-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (Arabic Edition)

International Nuclear Information System (INIS)

2014-01-01

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

Use of thermal infrared imaging for monitoring renewed dome growth at Mount St. Helens, 2004: Chapter 17 in A volcano rekindled: the renewed eruption of Mount St. Helens, 2004-2006

Science.gov (United States)

Schneider, David J.; Vallance, James W.; Wessels, Rick L.; Logan, Matthew; Ramsey, Michael S.; Sherrod, David R.; Scott, William E.; Stauffer, Peter H.

2008-01-01

A helicopter-mounted thermal imaging radiometer documented the explosive vent-clearing and effusive phases of the eruption of Mount St. Helens in 2004. A gyrostabilized gimbal controlled by a crew member housed the radiometer and an optical video camera attached to the nose of the helicopter. Since October 1, 2004, the system has provided thermal and video observations of dome growth. Flights conducted as frequently as twice daily during the initial month of the eruption monitored rapid changes in the crater and 1980-86 lava dome. Thermal monitoring decreased to several times per week once dome extrusion began. The thermal imaging system provided unique observations, including timely recognition that the early explosive phase was phreatic, location of structures controlling thermal emissions and active faults, detection of increased heat flow prior to the extrusion of lava, and recognition of new lava extrusion. The first spines, 1 and 2, were hotter when they emerged (maximum temperature 700-730°C) than subsequent spines insulated by as much as several meters of fault gouge. Temperature of gouge-covered spines was about 200°C where they emerged from the vent, and it decreased rapidly with distance from the vent. The hottest parts of these spines were as high as 500-730°C in fractured and broken-up regions. Such temperature variation needs to be accounted for in the retrieval of eruption parameters using satellite-based techniques, as such features are smaller than pixels in satellite images.

Managing public and media response to a reawakening volcano: lessons from the 2004 eruptive activity of Mount St. Helens: Chapter 23 in A volcano rekindled: the renewed eruption of Mount St. Helens, 2004-2006

Science.gov (United States)

Frenzen, Peter M.; Matarrese, Michael T.; Sherrod, David R.; Scott, William E.; Stauffer, Peter H.

2008-01-01

Volcanic eruptions and other infrequent, large-scale natural disturbances pose challenges and opportunities for public-land managers. In the days and weeks preceding an eruption, there can be considerable uncertainty surrounding the magnitude and areal extent of eruptive effects. At the same time, public and media interest in viewing developing events is high and concern for public safety on the part of local land managers and public safety officials is elevated. Land managers and collaborating Federal, State, and local officials must decide whether evacuations or restrictions to public access are necessary, the appropriate level of advance preparation, and how best to coordinate between overlapping jurisdictions. In the absence of a formal Federal or State emergency declaration, there is generally no identified source of supplemental funding for emergency-response preparation or managing extraordinary public and media response to developing events. In this chapter, we examine responses to escalating events that preceded the 2004 Mount St. Helens eruption and changes in public perception during the extended period of the largely nonexplosive, dome-building eruption that followed. Lessons learned include the importance of maintaining up-to-date emergency-response plans, cultivating close working relationships with collaborating agencies, and utilizing an organized response framework that incorporates clearly defined roles and responsibilities and effective communication strategies.

Pediatric oncologists' attitudes towards involving adolescents in decision-making concerning research participation.

Science.gov (United States)

de Vries, Martine C; Wit, Jan M; Engberts, Dirk P; Kaspers, Gertjan J L; van Leeuwen, Evert

2010-07-15

Various regulations and guidelines stipulate the importance of involving adolescents in decision-making concerning research participation. Several studies have shown that in the context of pediatric oncology this involvement is difficult to achieve due to emotional stress, the complexity of research protocols and limited time. Still, up to 80% of adolescents with cancer enter onto a trial during their illness. The aim of this study was to determine clinicians' views and attitudes towards enrolling adolescents in research, considering the difficulties surrounding their involvement in decision-making. A qualitative multicenter study was performed, using in-depth semi-structured interviews on the informed consent process with 15 pediatric hemato-oncologists. Four central themes emerged that characterize clinicians' attitudes towards involving adolescents in the decision-making process: (1) clinicians regard most adolescents as not capable of participating meaningfully in discussions regarding research; (2) clinicians do not always provide adolescents with all information; (3) proxy consent from parents is obtained and is deemed sufficient; (4) clinician-investigator integrity: clinicians judge research protocols as not being harmful and even in the best interest of the adolescent. Clinicians justify not involving adolescents in research discussions by referring to best interest arguments (adolescents' incompetence, proxy consent, and investigator integrity), although this is not in line with legal regulations and ethical guidelines.

The Effect of Gynecologic Oncologist Availability on Ovarian Cancer Mortality

Science.gov (United States)

Stewart, Sherri L.; Cooney, Darryl; Hirsch, Shawn; Westervelt, Lauren; Richards, Thomas B.; Rim, Sun Hee; Thomas, Cheryll C.

2015-01-01

AIM To determine the association between the distribution of gynecologic oncologist (GO) and population-based ovarian cancer death rates. MATERIALS AND METHODS Data on ovarian cancer incidence and mortality in the United States (U.S.) was supplemented with U.S. census data, and analyzed in relation to practicing GOs. GO locations were geocoded to link association between county variables and GO availability. Logistic regression was used to measure areas of high and low ovarian cancer mortality, adjusting for contextual variables. RESULTS Practicing GOs were unevenly distributed in the United States, with the greatest numbers in metropolitan areas. Ovarian cancer incidence and death rates increased as distance to a practicing GO increased. A relatively small number (153) of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates. Counties located 50 or more miles away from a GO practice had an almost 60% greater odds of high ovarian cancer mortality compared to those with closer practicing GOs (OR 1.59, 95% CI 1.18–2.15). CONCLUSION The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality. Efforts that facilitate outreach of GOs to certain populations may increase geographic access. Future studies examining other factors associated with lack of GO access (e.g. insurance and other socioeconomic factors) at the individual level will assist with further defining barriers to quality ovarian cancer care in the United States. PMID:26478860

Breaking bad news issues: A survey among radiation oncologists

Directory of Open Access Journals (Sweden)

Milind Kumar

2009-01-01

Full Text Available Introduction: Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice. Materials and Methods: We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients. Results: Most responders had an oncology experience of three to seven years (20/35.Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35 believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35 agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35 admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer. Conclusion: Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.

Pseudotachylyte formation in volcanic conduits: Montserrat vs. Mount St. Helens

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Kendrick, J. E.; Lavallee, Y.; Petrakova, L.; Ferk, A.; Di Toro, G.; Hess, K.; Ferri, F.; Dingwell, D. B.

2012-12-01

Seismogenic fracture and faulting may result in non-equilibrium frictional melting of rock, which upon cooling and recrystallisation forms pseudotachylyte. In volcanic environments, the transition from endogenous to exogenous growth can be attributed to a shift in magma rheology into the brittle regime, and thus the ascent of high-viscosity magma can form discrete shear zones, comparable to tectonic faults, along conduit margins. Pseudotachylytes have, until now, rarely been noted in exogenous volcanic materials and seldom in active volcanic environments. This is despite the simultaneous occurrence of high pressures and differential stresses, which make high-viscosity magmas ideal candidates for the occurrence of frictional melting. Here, we compare the chemical, thermal, magnetic and structural properties of two candidate volcanic pseudotachylytes; one from Soufriere Hills (Montserrat) and one from Mount St. Helens (USA). Additionally, we present data from a set of high-velocity rotary shear experiments on the host materials of these natural pseudotachylytes in which melting was induced after just 10's of centimeters of slip at realistic extrusion velocities (0.4 - 1.6 ms-1) and low normal stresses (0.5-2 MPa). After 1-2 meters of slip a continuous melt layer formed, at which point friction decreased and the fault zone displayed slip-weakening behaviour. For volcanic conduits, this would facilitate temporarily elevated slip rates, or an increase in extrusion rate, and could cause transitions in dome morphology and eruption style. This study demonstrates that shear fracturing in magma or sliding along conduit margins can readily result in frictional melting. The conspicuous absence of pseudotachylytes in active volcanic environments is likely the result of exceptionally high background temperatures which precipitate near-equilibrium melting, thereby obviating one of the characteristic signatures of pseudotachylyte - glassy protomelts formed by selective melting of

Estimating risks of radiotherapy complications as part of informed consent: the high degree of variability between radiation oncologists may be related to experience

International Nuclear Information System (INIS)

Shakespeare, Thomas Philip; Dwyer, Mary; Mukherjee, Rahul; Yeghiaian-Alvandi, Roland; Gebski, Val

2002-01-01

Purpose: Estimating the risks of radiotherapy (RT) toxicity is important for informed consent; however, the consistency in estimates has not been studied. This study aimed to explore the variability and factors affecting risk estimates (REs). Methods and Materials: A survey was mailed to Australian radiation oncologists, who were asked to estimate risks of RT complications given 49 clinical scenarios. The REs were assessed for association with oncologist experience, subspecialization, and private practice. Results: The REs were extremely variable, with a 50-fold median variability. The least variability (sevenfold) was for estimates of late, small intestinal perforation/obstruction after a one-third volume received 50 Gy with concurrent 5-fluorouracil (RE range 5-35%). The variation between the smallest and largest REs in 17 scenarios was ≥100-fold. The years of experience was significantly associated with REs of soft/connective-tissue toxicity (p=0.01) but inversely associated with estimates of neurologic/central nervous system toxicity (p=0.08). Ninety-six percent of respondents believed REs were important to RT practice; only 24% rated evidence to support their estimates as good. Sixty-seven percent believed national/international groups should pursue the issue further. Conclusion: Enormous variability exists in REs for normal tissue complications due to RT that is influenced by the years of experience. Risk estimation is perceived as an important issue without a good evidence base. Additional studies are strongly recommended

Biosimilars 101: considerations for U.S. oncologists in clinical practice

International Nuclear Information System (INIS)

Camacho, Luis H; Frost, Craig P; Abella, Esteban; Morrow, Phuong K; Whittaker, Sadie

2014-01-01

Biosimilars of biologics used for cancer treatment and supportive care are expected to enter the U.S. market soon. Biosimilars will be highly similar to their reference products, but unlike generic drugs, not identical. Differences between a biosimilar and its reference product may arise because of the complexity of biologics, and differences in the cell lines and processes used during manufacturing. Biosimilars will be approved in the United States through a regulatory pathway based on comparative analytical and clinical studies for their characterization and demonstration of no clinically meaningful differences from their reference products. Unlike generics, initial approval may not include interchangeability, as additional evidence may be required before a biosimilar could be approved as interchangeable with its reference product; interchangeable designation could allow pharmacy-level substitution without prescriber intervention. In some cases, the U.S. Food and Drug Administration (FDA) may extrapolate an indication that has not been formally investigated for the biosimilar but that is approved for the reference product. Robust safety monitoring of all biologics is important to track and accurately attribute adverse events, particularly because their inherent complexity and manufacturing differences make them susceptible to structural changes that can affect safety (e.g., immunogenicity). Accuracy of postapproval safety reports will partly depend on the biosimilar naming approach. Potential cost savings should be evaluated in the context of differences in manufacturers' patient-assistance programs, copayments, and institutional costs. A manufacturer's ability to ensure reliable supply of high-quality biosimilars should also be considered. Broad understanding of these issues is critical for oncologists preparing for their use in clinical practice

Large-scale magnetic field perturbation arising from the 18 May 1980 eruption from Mount St. Helens, Washington

Science.gov (United States)

Mueller, R.J.; Johnston, M.J.S.

1989-01-01

A traveling magnetic field disturbance generated by the 18 may 1980 eruption of Mount St. Helens at 1532 UT was detected on an 800-km linear array of recording magnetometers installed along the San Andreas fault system in California, from San Francisco to the Salton Sea. Arrival times of the disturbance field, from the most northern of these 24 magnetometers (996 km south of the volcano) to the most southern (1493 km S23?? E), are consistent with the generation of a traveling ionospheric disturbance stimulated by the blast pressure wave in the atmosphere. The first arrivals at the north and the south ends of the array occurred at 26 and 48 min, respectively, after the initial eruption. Apparent average wave velocity through the array is 309 ?? 14 m s-1 but may have approached 600 m s-1 close to the volcano. The horizontal phase and the group velocity of ??? 300 m s-1 at periods of 70-80 min, and the attenuation with distance, strongly suggest that the magnetic field perturbations at distances of 1000-1500 km are caused by gravity mode acoustic-gravity waves propagating at F-region heights in the ionosphere. ?? 1989.

Mobile Technology and Social Media in the Clinical Practice of Young Radiation Oncologists: Results of a Comprehensive Nationwide Cross-sectional Study

Energy Technology Data Exchange (ETDEWEB)

Bibault, Jean-Emmanuel, E-mail: jebibault@gmail.com [Academic Radiation Oncology Department, Oscar Lambret Center, Lille (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); Leroy, Thomas [Academic Radiation Oncology Department, Oscar Lambret Center, Lille (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); Blanchard, Pierre [Academic Radiation Oncology Department, Gustave Roussy Institute, Villejuif Cedex (France); Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif Cedex (France); Biau, Julian [Radiation Oncology Department, Jean-Perrin Center, Clermont-Ferrand cedex (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); Cervellera, Mathilde [Radiation Oncology Department, Jean-Godinot Center, Reims (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); Diaz, Olivia [Radiation Oncology Department, Lyon Sud University Hospital, Pierre-Bénite Cedex (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); Faivre, Jean Christophe [Academic Radiation Oncology and Brachytherapy Departement, Alexis-Vautrin Center, Avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy (France); French Society of Young Radiation Oncologists (SFjRO), Centre Antoine-Béclère, Paris (France); and others

2014-09-01

Purpose: Social media and mobile technology are transforming the way in which young physicians are learning and practicing medicine. The true impact of such technologies has yet to be evaluated. Methods and Materials: We performed a nationwide cross-sectional survey to better assess how young radiation oncologists used these technologies. An online survey was sent out between April 24, 2013, and June 1, 2013. All residents attending the 2013 radiation oncology French summer course were invited to complete the survey. Logistic regressions were performed to assess predictors of use of these tools in the hospital on various clinical endpoints. Results: In all, 131 of 140 (93.6%) French young radiation oncologists answered the survey. Of these individuals, 93% owned a smartphone and 32.8% owned a tablet. The majority (78.6%) of the residents owning a smartphone used it to work in their department. A total of 33.5% had more than 5 medical applications installed. Only 60.3% of the residents verified the validity of the apps that they used. In all, 82.9% of the residents had a social network account. Conclusions: Most of the residents in radiation oncology use their smartphone to work in their department for a wide variety of tasks. However, the residents do not consistently check the validity of the apps that they use. Residents also use social networks, with only a limited impact on their relationship with their patients. Overall, this study highlights the irruption and the risks of new technologies in the clinical practice and raises the question of a possible regulation of their use in the hospital.

Mobile technology and social media in the clinical practice of young radiation oncologists: results of a comprehensive nationwide cross-sectional study.

Science.gov (United States)

Bibault, Jean-Emmanuel; Leroy, Thomas; Blanchard, Pierre; Biau, Julian; Cervellera, Mathilde; Diaz, Olivia; Faivre, Jean Christophe; Fumagalli, Ingrid; Lescut, Nicolas; Martin, Valentine; Pichon, Baptiste; Riou, Olivier; Thureau, Sébastien; Giraud, Philippe

2014-09-01

Social media and mobile technology are transforming the way in which young physicians are learning and practicing medicine. The true impact of such technologies has yet to be evaluated. We performed a nationwide cross-sectional survey to better assess how young radiation oncologists used these technologies. An online survey was sent out between April 24, 2013, and June 1, 2013. All residents attending the 2013 radiation oncology French summer course were invited to complete the survey. Logistic regressions were performed to assess predictors of use of these tools in the hospital on various clinical endpoints. In all, 131 of 140 (93.6%) French young radiation oncologists answered the survey. Of these individuals, 93% owned a smartphone and 32.8% owned a tablet. The majority (78.6%) of the residents owning a smartphone used it to work in their department. A total of 33.5% had more than 5 medical applications installed. Only 60.3% of the residents verified the validity of the apps that they used. In all, 82.9% of the residents had a social network account. Most of the residents in radiation oncology use their smartphone to work in their department for a wide variety of tasks. However, the residents do not consistently check the validity of the apps that they use. Residents also use social networks, with only a limited impact on their relationship with their patients. Overall, this study highlights the irruption and the risks of new technologies in the clinical practice and raises the question of a possible regulation of their use in the hospital. Copyright © 2014 Elsevier Inc. All rights reserved.

Mobile Technology and Social Media in the Clinical Practice of Young Radiation Oncologists: Results of a Comprehensive Nationwide Cross-sectional Study

International Nuclear Information System (INIS)

Bibault, Jean-Emmanuel; Leroy, Thomas; Blanchard, Pierre; Biau, Julian; Cervellera, Mathilde; Diaz, Olivia; Faivre, Jean Christophe

2014-01-01

Purpose: Social media and mobile technology are transforming the way in which young physicians are learning and practicing medicine. The true impact of such technologies has yet to be evaluated. Methods and Materials: We performed a nationwide cross-sectional survey to better assess how young radiation oncologists used these technologies. An online survey was sent out between April 24, 2013, and June 1, 2013. All residents attending the 2013 radiation oncology French summer course were invited to complete the survey. Logistic regressions were performed to assess predictors of use of these tools in the hospital on various clinical endpoints. Results: In all, 131 of 140 (93.6%) French young radiation oncologists answered the survey. Of these individuals, 93% owned a smartphone and 32.8% owned a tablet. The majority (78.6%) of the residents owning a smartphone used it to work in their department. A total of 33.5% had more than 5 medical applications installed. Only 60.3% of the residents verified the validity of the apps that they used. In all, 82.9% of the residents had a social network account. Conclusions: Most of the residents in radiation oncology use their smartphone to work in their department for a wide variety of tasks. However, the residents do not consistently check the validity of the apps that they use. Residents also use social networks, with only a limited impact on their relationship with their patients. Overall, this study highlights the irruption and the risks of new technologies in the clinical practice and raises the question of a possible regulation of their use in the hospital

National Medical Care System May Impede Fostering of True Specialization of Radiation Oncologists: Study Based on Structure Survey in Japan

Energy Technology Data Exchange (ETDEWEB)

Numasaki, Hodaka [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Shibuya, Hitoshi [Department of Radiology, Tokyo Medical and Dental University, Tokyo (Japan); Nishio, Masamichi [Department of Radiology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido (Japan); Ikeda, Hiroshi [Department of Radiology, Sakai Municipal Hospital, Sakai, Osaka (Japan); Sekiguchi, Kenji [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan); Kamikonya, Norihiko [Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo (Japan); Koizumi, Masahiko [Oncology Center, Osaka University Hospital, Suita, Osaka (Japan); Tago, Masao [Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki, Kanagawa (Japan); Ando, Yutaka [Department of Medical Informatics, Heavy Ion Medical Center, National Institute of Radiological Sciences, Chiba (Japan); Tsukamoto, Nobuhiro [Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama (Japan); Terahara, Atsuro [Department of Radiology, Toho University Omori Medical Center, Tokyo (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Mitsumori, Michihide [Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine Kyoto University, Kyoto (Japan); Nishimura, Tetsuo [Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka (Japan); Hareyama, Masato [Department of Radiology, Sapporo Medical University, Hokkaido (Japan); Teshima, Teruki, E-mail: teshima@sahs.med.osaka-u.ac.jp [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka (Japan)

2012-01-01

Purpose: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. Methods and Materials: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). Results: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). Conclusions: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

National medical care system may impede fostering of true specialization of radiation oncologists: study based on structure survey in Japan.

Science.gov (United States)

Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi; Ikeda, Hiroshi; Sekiguchi, Kenji; Kamikonya, Norihiko; Koizumi, Masahiko; Tago, Masao; Ando, Yutaka; Tsukamoto, Nobuhiro; Terahara, Atsuro; Nakamura, Katsumasa; Mitsumori, Michihide; Nishimura, Tetsuo; Hareyama, Masato; Teshima, Teruki

2012-01-01

To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists. Copyright © 2012 Elsevier Inc. All rights reserved.

Informação ao paciente com câncer: o olhar do oncologista Information to the patient with cancer: the oncologist's view

Directory of Open Access Journals (Sweden)

Paula Danielle Santa Maria de Albuquerque

2011-04-01

Full Text Available OBJETIVO: Identificar o que os médicos-oncologistas informam aos seus pacientes, verificar o que levam em consideração no processo de informar, e averiguar a quem fornecem a informação. MÉTODOS: Os sujeitos da pesquisa foram oncologistas, recrutados dentre aqueles inscritos na Sociedade Brasileira de Oncologia Clínica (SBOC. Foi enviado para a sociedade, via correio, todo o material a ser encaminhado aos oncologistas. Os envelopes, selados previamente, continham: formulário para coleta de dados e informações para o preenchimento e termo de consentimento livre e esclarecido (TCLE. Os dados obtidos foram tratados estatisticamente obedecendo a um intervalo de confiança de 95%. RESULTADOS: Foram encaminhadas 876 correspondências (total de médicos associados à SBOC e obteve-se um índice de 16,55% de resposta. Quanto ao que informam, 81% dos médicos responderam que informavam o diagnóstico, o tratamento e o prognóstico aos seus pacientes; entretanto, 73% relataram que, em grande parte dos casos, o paciente já tem conhecimento da sua doença. Por sua vez, a informação é fornecida ao paciente e à sua família por 81% dos médicos. Dentre os aspectos relevantes no processo de informar, destaca-se que o gênero do paciente pouco influencia na informação para 95% dos médicos. CONCLUSÃO: Diante dos resultados apresentados, conclui-se que na população estudada existe a preocupação em informar adequando-se ao perfil do paciente. Percebe-se, ainda, que os oncologistas tentam prover o paciente do que lhe é de direito - a verdade -, embora muitas vezes recorram à família para auxiliar no fornecimento das informações.OBJECTIVE: To identify what information is provided to the patients by oncologists, assess what they take into account in the process of informing the patient, and to ascertain whom the information is provided to. METHODS: The study subjects were oncologists recruited among those registered at the Brazilian Society

Erosion by flowing lava: Geochemical evidence in the Cave Basalt, Mount St. Helens, Washington

Science.gov (United States)

Williams, D.A.; Kadel, S.D.; Greeley, R.; Lesher, C.M.; Clynne, M.A.

2004-01-01

We sampled basaltic lava flows and underlying dacitic tuff deposits in or near lava tubes of the Cave Basalt, Mount St. Helens, Washington to determine whether the Cave Basalt lavas contain geochemical evidence of substrate contamination by lava erosion. The samples were analyzed using a combination of wavelength-dispersive X-ray fluorescence spectrometry and inductively-coupled plasma mass spectrometry. The results indicate that the oldest, outer lava tube linings in direct contact with the dacitic substrate are contaminated, whereas the younger, inner lava tube linings are uncontaminated and apparently either more evolved or enriched in residual liquid. The most heavily contaminated lavas occur closer to the vent and in steeper parts of the tube system, and the amount of contamination decreases with increasing distance downstream. These results suggest that erosion by lava and contamination were limited to only the initially emplaced flows and that erosion was localized and enhanced by vigorous laminar flow over steeper slopes. After cooling, the initial Cave Basalt lava flows formed an insulating lining within the tubes that prevented further erosion by later flows. This interpretation is consistent with models of lava erosion that predict higher erosion rates closer to sources and over steeper slopes. A greater abundance of xenoliths and xenocrysts relative to xenomelts in hand samples indicates that mechanical erosion rather than thermal erosion was the dominant erosional process in the Cave Basalt, but further sampling and petrographic analyses must be performed to verify this hypothesis. ?? Springer-Verlag 2003.

Four-year prospective study of the respiratory effects of volcanic ash from Mt. St. Helens

International Nuclear Information System (INIS)

Buist, A.S.; Vollmer, W.M.; Johnson, L.R.; Bernstein, R.S.; McCamant, L.E.

1986-01-01

This report describes the 4-yr follow-up of 712 loggers exposed over an extended period to varying levels of fresh volcanic ash from the 1980 eruptions of Mt. St. Helens. Concerns related to the irritant effect the ash might have on the airways and also to its fibrogenic potential if exposures were intense and continued over many years. Our subjects were divided into 3 groups: high, low, and no exposure. Baseline testing was begun in June 1980, 1 month after the major eruption, and follow-up testing continued on an annual basis through 1984; 88% of the loggers have been tested at least 3 times. Analysis of lung function data showed that a significant, exposure-related decline in FEV1 occurred during the first year after the eruption. The decline was short-lived, however, and by 1984 the differences between exposure groups were no longer significant. Self-reported symptoms of cough, phlegm, and wheeze showed a similar pattern. No ash-related changes were seen in chest roentgenograms taken in 1980 and in 1984. Our findings are consistent with the hypothesis that the inhaled ash caused mucus hypersecretion and/or airway inflammation that reversed when the exposure levels decreased. The ash levels to which the loggers were exposed were low compared with permissible occupational levels for nuisance dusts, but generally higher than the total suspended particulate levels permissible in ambient air

Defining and managing career challenges for mid-career and senior stage pediatric hematologist/oncologists.

Science.gov (United States)

Frugé, Ernest; Margolin, Judith; Horton, Terzah; Venkateswaran, Lakshmi; Lee, Dean; Yee, Donald L; Mahoney, Donald

2010-12-01

A workshop at the 2008 ASPHO Annual Meeting functioned as the first step in a systematic needs assessment of the particular challenges to satisfaction and success in the middle and senior phases of career development for pediatric hematologist/oncologists (PHOs). The 61 ASPHO members who attended were randomly distributed to small discussion groups based on self-identified career stage. Groups completed challenge forms for each issue identified as pertinent to their own stage of professional development. A total of 71 forms with useable data were generated by the groups. The largest number of challenges described (26) clustered around themes of Work-Life Balance followed by Transition and Succession (18), Management and Finances (15), and Keeping up to Date (13). Mid-career groups were more likely to identify Work-Life Balance challenges while senior stage groups were more likely to articulate Succession and Management challenges. The article describes the demographics of the workshop participants, summarizes the content of challenge themes and the associated suggestions for management. It is hoped that this effort will assist educational and career planning efforts by individuals, institutions, and ASPHO as a professional society.

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients.

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Bartels, Josef; Rodenbach, Rachel; Ciesinski, Katherine; Gramling, Robert; Fiscella, Kevin; Epstein, Ronald

2016-10-01

Silences in doctor-patient communication can be "connectional" and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients. Two medical students and a professor of voice screened all 1211 silences over 2s in length from 124 oncology office visits. We developed a "strength of connection" taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm. We identified connectional silences with good reliability. Typical dialog rhythms surrounding connectional silences are characterized by relatively equal turn lengths and frequent short vocalizations. We found no pattern of volume and pitch variability around these silences. Connectional silences occurred in a wide variety of lexical contexts. Particular patterns of dialog rhythm mark connectional silences. Exploring structures of connectional silence extends our understanding of the audio-linguistic conditions that mark patient-clinician connection. Communicating with an awareness of pitch, rhythm, and silence - in addition to lexical content - can facilitate shared understanding and emotional connection. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sources and resources for oncologists to help answer the question: is PET/CT appropriate for my patient?

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Karantanis, Dimitrios; Allen-Auerbach, Martin; Czernin, Johannes

2012-01-01

Positron emission tomography (PET)/computed tomography (CT)-subsequently referred to as PET/CT is emerging as a critically important diagnostic tool in oncology. There has been a substantial increase in the utilization of this modality over the last decade. The optimal imaging protocols are, however, still not established which results in considerable confusion and uncertainty among referring physicians and providers. Oncologists, hematologists and other physicians managing oncologic patients frequently face the dilemma of whether or not to order a PET/CT scan for their patients. The large body of evidence from clinical research often overwhelms the ability of physicians to stay adequately informed on the disease specific performance of PET/CT. Moreover, regulatory agencies have changed their requirements for reimbursement of PET/CT scans in an effort to curtail health care expenditures. In this article we attempt to inform users and providers about the appropriate use of this technology.

Radiotherapy in the curative treatment of breast cancer: current status and future trends. An opinion sample of radiation oncologists active in breast cancer research

International Nuclear Information System (INIS)

Kurtz, J.M.

1994-01-01

A questionnaire regarding the current practice of breast cancer radiotherapy and possible future trends in this field was filled out by 13 radiation oncologists active in breast cancer research. In the opinion of this small group, radiotherapy is presently included in the initial treatment of the large majority of early breast cancers, particularly in the framework of breast-conserving therapy, which is currently used in >50% of these patients. Indications for post-mastectomy irradiation vary greatly among respondents, as do attitudes toward the potentially negative aspects of adjuvant radiotherapy. Most respondents feel that their future practices will be significantly influenced by an increase in screen-detected cancers, the aging of the population, the increasing influence of medical oncologists, participation in clinical trials, and increased patient participation in treatment decisions. An increase is foreseen in the use of breast-conserving approaches, radiotherapy, and systemic therapies, and a decrease in the use of both total mastectomy and axillary dissection. Most respondents feel that there will be a modest decrease in the percentage of conservatively operated patients receiving radiotherapy. A future role is seen for neo-adjuvant chemotherapy, at least in well-defined subgroups, increasing the number of patients offered breast-conserving approaches. Most respondents expect that irradiation of lymph nodal areas will gain new credibility and be used more often. No majority opinion could be elicited regarding ways of improving the therapeutic ratio in breast cancer radiotherapy. (author)

Correlations of turbidity to suspended-sediment concentration in the Toutle River Basin, near Mount St. Helens, Washington, 2010-11

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Uhrich, Mark A.; Kolasinac, Jasna; Booth, Pamela L.; Fountain, Robert L.; Spicer, Kurt R.; Mosbrucker, Adam R.

2014-01-01

Researchers at the U.S. Geological Survey, Cascades Volcano Observatory, investigated alternative methods for the traditional sample-based sediment record procedure in determining suspended-sediment concentration (SSC) and discharge. One such sediment-surrogate technique was developed using turbidity and discharge to estimate SSC for two gaging stations in the Toutle River Basin near Mount St. Helens, Washington. To provide context for the study, methods for collecting sediment data and monitoring turbidity are discussed. Statistical methods used include the development of ordinary least squares regression models for each gaging station. Issues of time-related autocorrelation also are evaluated. Addition of lagged explanatory variables was used to account for autocorrelation in the turbidity, discharge, and SSC data. Final regression model equations and plots are presented for the two gaging stations. The regression models support near-real-time estimates of SSC and improved suspended-sediment discharge records by incorporating continuous instream turbidity. Future use of such models may potentially lower the costs of sediment monitoring by reducing time it takes to collect and process samples and to derive a sediment-discharge record.

Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians' perspectives.

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Johnson, Stephanie B; Butow, Phyllis N; Kerridge, Ian; Tattersall, Martin H N

2018-02-01

Patients' are encouraged to participate in advance care planning (ACP) in order to enhance their autonomy. However, controversy exists as to what it means to be autonomous and there is limited understanding of how social and structural factors may influence cancer patients' ability to exercise their autonomy. The objective of this study is to explore oncologists' and palliative care physicians' understanding of patient autonomy, how this influences reported enactment of decision-making at the end of life (EOL), and the role of ACP in EOL care. Qualitative semi-structured interviews were conducted with consultant oncologists (n = 11) and palliative medicine doctors (n = 7) working in oncology centres and palliative care units across Australia. We found that doctors generally conceptualized autonomy in terms of freedom from interference but that there was a profound disconnect between this understanding of autonomy and clinical practice in EOL decision-making. The clinicians in our study privileged care, relationships and a 'good death' above patient autonomy, and in practice were reluctant to 'abandon' their patients to total non-interference in decision-making. Patient autonomy in healthcare is bounded, as while patients were generally encouraged to express their preferences for care, medical norms about the quality and 'reasonableness' of care, the availability of services and the patients' family relationships act to enhance or limit patients' capacity to realize their preferences. While for many, this disconnect between theory and practice did not diminish the rhetorical appeal of ACP; for others, this undermined the integrity of ACP, as well as its relevance to care. For some, ACP had little to do with patient autonomy and served numerous other ethical, practical and political functions. The ethical assumptions regarding patient autonomy embedded in academic literature and policy documents relating to ACP are disconnected from the realities of clinical care

Oncologist Support for Consolidated Payments for Cancer Care Management in the United States.

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Narayanan, Siva; Hautamaki, Emily

2016-07-01

The cost of cancer care in the United States continues to rise, with pressure on oncologists to provide high-quality, cost-effective care while maintaining the financial stability of their practice. Existing payment models do not typically reward care coordination or quality of care. In May 2014, the American Society of Clinical Oncology (ASCO) released a payment reform proposal (revised in May 2015) that includes a new payment structure for quality-of-care performance metrics. To assess US oncologists' perspectives on and support for ASCO's payment reform proposal, and to determine use of quality-of-care metrics, factors influencing their perception of value of new cancer drugs, the influence of cost on treatment decisions, and the perceptions of the reimbursement climate in the country. Physicians and medical directors specializing in oncology in the United States practicing for at least 2 years and managing at least 20 patients with cancer were randomly invited, from an online physician panel, to participate in an anonymous, cross-sectional, 15-minute online survey conducted between July and November 2014. The survey assessed physicians' level of support for the payment reform, use of quality-of-care metrics, factors influencing their perception of the value of a new cancer drug, the impact of cost on treatment decision-making, and their perceptions of the overall reimbursement climate. Descriptive statistics (chi-square tests and t-tests for discrete and continuous variables, respectively) were used to analyze the data. Logistic regression models were constructed to evaluate the main payment models described in the payment reform proposal. Of the 231 physicians and medical directors who participated in this study, approximately 50% strongly or somewhat supported the proposed payment reform. Stronger support was seen among survey respondents who were male, who rated the overall reimbursement climate as excellent/good, who have a contract with a commercial payer

A Patterns of Care Study of the Various Radiation Therapies for Prostate Cancer among Korean Radiation Oncologists in 2006

International Nuclear Information System (INIS)

Kim, Jin Hee; Kim, Jae Sung; Ha, Sung Whan

2008-01-01

To conduct a nationwide academic hospital patterns of the practice status and principles of radiotherapy for prostate cancer. The survey will help develop the framework of a database of Korean in Patterns of Case Study. A questionnaire about radiation treatment status and principles was sent to radiation oncologists in charge of prostate cancer treatment at thirteen academic hospitals in Korea. The data was analyzed to find treatment principles among the radiation oncologists when treating prostate cancer. The number of patients with prostate cancer and treated with radiation ranged from 60 to 150 per academic hospital in Seoul City and 10 to 15 outside of Seoul City in 2006. The primary diagnostic methods of prostate cancer included the ultrasound guided biopsy on 6 to 12 prostate sites (mean=9), followed by magnetic resonance imaging and a whole body bone scan. Internal and external immobilizations were used in 61.5% and 76.9%, respectively, with diverse radiation targets. Whole pelvis radiation therapy (dose ranging from 45.0 to 50.4 Gy) was performed in 76.9%, followed by the irradiation of seminal vesicles (54.0∼73.8 Gy) in 92.3%. The definitive radiotherapy doses were increased as a function of risk group, but the range of radiation doses was wide (60.0 to 78.5 Gy). Intensity modulated radiation therapy using doses greater than 70 Gy, were performed in 53.8% of academic hospitals. In addition, the simultaneous intra-factional boost (SIB) technique was used in three hospitals; however, the target volume and radiation dose were diverse. Radiation therapy to biochemical recurrence after a radical prostatectomy was performed in 84.6%; however, the radiation dose was variable and the radiation field ranged from whole pelvis to prostate bed. The results of this study suggest that a nationwide Korean Patterns of Care Study is necessary for the recommendation of radiation therapy guidelines of prostate cancer

Physicians' age and sex influence breaking bad news to elderly cancer patients. Beliefs and practices of 50 Italian oncologists: the G.I.O.Ger study.

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Locatelli, C; Piselli, P; Cicerchia, M; Repetto, L

2013-05-01

We attempt to shed light on the truth-telling attitudes and practices of oncologists working with a geriatric population in Italy. Physicians caring for cancer patients were asked to complete a specific survey centred on their beliefs, attitudes and practices towards truth telling to elderly cancer patients. Of 50 physicians surveyed, 68% were men. Physicians practising in the south of Italy were significantly older and more likely to be of male gender in comparison with physicians practising from the north and central areas. Eighty-four per cent of physicians consider the family to be an obstacle to a direct communication with the elderly. Forty-four per cent of male physicians who are faced with a family's request of nondisclosure talk with the patient, whereas 37.5% of female physicians talk with the family. For 60% of interviewed physicians, the reason underpinning the caregiver's choice of nondisclosure is to delay the emotional confrontation. We observed that variability of disclosure is related not only to the patient's age but also to the physicians' age and sex and to the geographic area where physicians work. The results also show that both caregivers and physicians are concerned by the emotional aspects related to clinical information. Italian oncologists have to learn and implement 'comprehensive' communication skills and have to promote an integration of the information needs of patient and caregivers, according to their socio-cultural affiliation, within the communication techniques. Copyright © 2012 John Wiley & Sons, Ltd.

The effect of consumers and mutualists of Vaccinium membranaceum at Mount St. Helens: dependence on successional context.

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Suann Yang

Full Text Available In contrast to secondary succession, studies of terrestrial primary succession largely ignore the role of biotic interactions, other than plant facilitation and competition, despite the expectation that simplified interaction webs and propagule-dependent demographics may amplify the effects of consumers and mutualists. We investigated whether successional context determined the impact of consumers and mutualists by quantifying their effects on reproduction by the shrub Vaccinium membranaceum in primary and secondary successional sites at Mount St. Helens (Washington, USA, and used simulations to explore the effects of these interactions on colonization. Species interactions differed substantially between sites, and the combined effect of consumers and mutualists was much more strongly negative for primary successional plants. Because greater local control of propagule pressure is expected to increase successional rates, we evaluated the role of dispersal in the context of these interactions. Our simulations showed that even a small local seed source greatly increases population growth rates, thereby balancing strong consumer pressure. The prevalence of strong negative interactions in the primary successional site is a reminder that successional communities will not exhibit the distribution of interaction strengths characteristic of stable communities, and suggests the potential utility of modeling succession as the consequence of interaction strengths.

Rapid, low-cost photogrammetry to monitor volcanic eruptions: an example from Mount St. Helens, Washington, USA

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Diefenbach, Angela K.; Crider, Juliet G.; Schilling, Steve P.; Dzurisin, Daniel

2012-01-01

We describe a low-cost application of digital photogrammetry using commercially available photogrammetric software and oblique photographs taken with an off-the-shelf digital camera to create sequential digital elevation models (DEMs) of a lava dome that grew during the 2004–2008 eruption of Mount St. Helens (MSH) volcano. Renewed activity at MSH provided an opportunity to devise and test this method, because it could be validated against other observations of this well-monitored volcano. The datasets consist of oblique aerial photographs (snapshots) taken from a helicopter using a digital single-lens reflex camera. Twelve sets of overlapping digital images of the dome taken during 2004–2007 were used to produce DEMs and to calculate lava dome volumes and extrusion rates. Analyses of the digital images were carried out using photogrammetric software to produce three-dimensional coordinates of points identified in multiple photos. The evolving morphology of the dome was modeled by comparing successive DEMs. Results were validated by comparison to volume measurements derived from traditional vertical photogrammetric surveys by the US Geological Survey Cascades Volcano Observatory. Our technique was significantly less expensive and required less time than traditional vertical photogrammetric techniques; yet, it consistently yielded volume estimates within 5% of the traditional method. This technique provides an inexpensive, rapid assessment tool for tracking lava dome growth or other topographic changes at restless volcanoes.

Two Millian Arguments: Using Helen Longino’s Approach to Solve the Problems Philip Kitcher Targeted with His Argument on Freedom of Inquiry

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Jaana Eigi

2012-12-01

Full Text Available Philip Kitcher argued that the freedom to pursue one's version of the good life is the main aim of Mill's argument for freedom of expression. According to Kitcher, in certain scientific fields, political and epistemological asymmetries bias research toward conclusions that threaten this most important freedom of underprivileged groups. Accordingly, Kitcher claimed that there are Millian grounds for limiting freedom of inquiry in these fields to protect the freedom of the underprivileged.I explore Kitcher's argument in light of the interpretation Helen Longino gave to Mill's argument. She argued that free critical dialogue in the community allows bias to be overcome, through intersubjective criticism of hypotheses and the background assumptions that frame them.I suggest that Longino's approach allows for the identification of the fundamental problems of the research programs Kitcher targeted, and for the rejection of their claims to knowledge. Thus it is possible to address Kitcher's problem without limiting freedom of speech.

Lateral blasts at Mount St. Helens and hazard zonation

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Crandell, D.R.; Hoblitt, R.P.

1986-01-01

Lateral blasts at andesitic and dacitic volcanoes can produce a variety of direct hazards, including ballistic projectiles which can be thrown to distances of at least 10 km and pyroclastic density flows which can travel at high speed to distances of more than 30 km. Indirect effect that may accompany such explosions include wind-borne ash, pyroclastic flows formed by the remobilization of rock debris thrown onto sloping ground, and lahars. Two lateral blasts occurred at a lava dome on the north flank of Mount St. Helens about 1200 years ago; the more energetic of these threw rock debris northeastward across a sector of about 30?? to a distance of at least 10 km. The ballistic debris fell onto an area estimated to be 50 km2, and wind-transported ash and lapilli derived from the lateral-blast cloud fell on an additional lobate area of at least 200 km2. In contrast, the vastly larger lateral blast of May 18, 1980, created a devastating pyroclastic density flow that covered a sector of as much as 180??, reached a maximum distance of 28 km, and within a few minutes directly affected an area of about 550 km2. The May 18 lateral blast resulted from the sudden, landslide-induced depressurization of a dacite cryptodome and the hydrothermal system that surrounded it within the volcano. We propose that lateral-blast hazard assessments for lava domes include an adjoining hazard zone with a radius of at least 10 km. Although a lateral blast can occur on any side of a dome, the sector directly affected by any one blast probably will be less than 180??. Nevertheless, a circular hazard zone centered on the dome is suggested because of the difficulty of predicting the direction of a lateral blast. For the purpose of long-term land-use planning, a hazard assessment for lateral blasts caused by explosions of magma bodies or pressurized hydrothermal systems within a symmetrical volcano could designate a circular potential hazard area with a radius of 35 km centered on the volcano

Airborne thermal infrared imaging of the 2004-2005 eruption of Mount St. Helens

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Schneider, D. J.; Vallance, J. W.; Logan, M.; Wessels, R.; Ramsey, M.

2005-12-01

A helicopter-mounted forward-looking infrared imaging radiometer (FLIR) documented the explosive and effusive activity at Mount St. Helens during the 2004-2005 eruption. A gyrostabilzed gimbal controlled by a crew member houses the FLIR radiometer and an optical video camera attached at the lower front of the helicopter. Since October 1, 2004 the system has provided an unprecedented data set of thermal and video dome-growth observations. Flights were conducted as frequently as twice daily during the initial month of the eruption (when changes in the crater and dome occurred rapidly), and have been continued on a tri-weekly basis during the period of sustained dome growth. As with any new technology, the routine use of FLIR images to aid in volcano monitoring has been a learning experience in terms of observation strategy and data interpretation. Some of the unique information that has been derived from these data to date include: 1) Rapid identification of the phreatic nature of the early explosive phase; 2) Observation of faulting and associated heat flow during times of large scale deformation; 3) Venting of hot gas through a short lived crater lake, indicative of a shallow magma source; 4) Increased heat flow of the crater floor prior to the initial dome extrusion; 5) Confirmation of new magma reaching the surface; 6) Identification of the source of active lava extrusion, dome collapse, and block and ash flows. Temperatures vary from ambient, in areas insulated by fault gouge and talus produced during extrusion, to as high as 500-740 degrees C in regions of active extrusion, collapse, and fracturing. This temperature variation needs to be accounted for in the retrieval of eruption parameters using satellite-based techniques as such features are sub-pixel size in satellite images.

The 2004–2008 dome-building eruption at Mount St. Helens, Washington: Epilogue

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Dzurisin, Daniel; Moran, Seth C.; Lisowski, Michael; Schilling, Steve P.; Anderson, Kyle R.; Werner, Cynthia A.

2015-01-01

The 2004–2008 dome-building eruption at Mount St. Helens ended during winter 2007–2008 at a time when field observations were hampered by persistent bad weather. As a result, recognizing the end of the eruption was challenging—but important for scientists trying to understand how and why long-lived eruptions end and for public officials and land managers responsible for hazards mitigation and access restrictions. In hindsight, the end of the eruption was presaged by a slight increase in seismicity in December 2007 that culminated on January 12–13, 2008, with a burst of more than 500 events, most of which occurred in association with several tremor-like signals and a spasmodic burst of long-period earthquakes. At about the same time, a series of regular, localized, small-amplitude tilt events—thousands of which had been recorded during earlier phases of the eruption—came to an end. Thereafter, seismicity declined to 10–20 events per day until January 27–28, when a spasmodic burst of about 50 volcano-tectonic earthquakes occurred over a span of 3 h. This was followed by a brief return of repetitive “drumbeat” earthquakes that characterized much of the eruption. By January 31, however, seismicity had declined to 1–2 earthquakes per day, a rate similar to pre-eruption levels. We attribute the tilt and seismic observations to convulsive stagnation of a semisolid magma plug in the upper part of the conduit. The upward movement of the plug ceased when the excess driving pressure, which had gradually decreased throughout the eruption as a result of reservoir deflation and increasing overburden from the growing dome, was overcome by increasing friction as a result of cooling and crystallization of the plug.

Clast comminution during pyroclastic density current transport: Mt St Helens

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Dawson, B.; Brand, B. D.; Dufek, J.

2011-12-01

Volcanic clasts within pyroclastic density currents (PDCs) tend to be more rounded than those in fall deposits. This rounding reflects degrees of comminution during transport, which produces an increase in fine-grained ash with distance from source (Manga, M., Patel, A., Dufek., J. 2011. Bull Volcanol 73: 321-333). The amount of ash produced due to comminution can potentially affect runout distance, deposit sorting, the volume of ash lofted into the upper atmosphere, and increase internal pore pressure (e.g., Wohletz, K., Sheridan, M. F., Brown, W.K. 1989. J Geophy Res, 94, 15703-15721). For example, increased pore pressure has been shown to produce longer runout distances than non-comminuted PDC flows (e.g., Dufek, J., and M. Manga, 2008. J. Geophy Res, 113). We build on the work of Manga et al., (2011) by completing a pumice abrasion study for two well-exposed flow units from the May 18th, 1980 eruption of Mt St Helens (MSH). To quantify differences in comminution from source, sampling and the image analysis technique developed in Manga et al., 2010 was completed at distances proximal, medial, and distal from source. Within the units observed, data was taken from the base, middle, and pumice lobes within the outcrops. Our study is unique in that in addition to quantifying the degree of pumice rounding with distance from source, we also determine the possible range of ash sizes produced during comminution by analyzing bubble wall thickness of the pumice through petrographic and SEM analysis. The proportion of this ash size is then measured relative to the grain size of larger ash with distance from source. This allows us to correlate ash production with degree of rounding with distance from source, and determine the fraction of the fine ash produced due to comminution versus vent-fragmentation mechanisms. In addition we test the error in 2D analysis by completing a 3D image analysis of selected pumice samples using a Camsizer. We find that the roundness of PDC

Revolution and Exploration: the English Translations of Rousseau and Humboldt by Helen Maria Williams

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Paula Yurss Lasanta

2017-12-01

Full Text Available British author Helen Maria Williams (1759-1827 was a well-known figure in the eighteenth century literary circles, whose work was praised by Elizabeth Montagu, Samuel Johnson, Dorothy and William Wordsworth, Mary Wollstonecraft, Hester Piozzi or Alexander von Humboldt.  In her early poems  Edwin and Eltruda (1782, An Ode to the Peace (1783 and Peru (1784, Williams starts to reveal her political tendencies by appealing to strong empathic feelings as a key to social and political transformation. As a result of her interest in politics, she travelled to France in 1790 and published her most acclaimed work Letters from France (1790. However, the rest of her production has received little critical attention by modern scholars, who have overlooked her involvement in translation. Williams’ only extant novel, Julia (1790 is in fact a creative translation of Rousseau’s Julie ou La Nouvelle Héloïse (1761, in which Williams includes poems that evidence her interest in revolutionary politics. Four years later, she translated Bernardin de Saint Pierre’s Paul et Virginie, while she was imprisoned in Paris. While translating novels was regarded as a respectable exercise for women writers, Williams challenges gender assumptions by translating Researches (1814 and the seven volumes of Personal Narrative (1814-1829, which had been produced by one of the most influential eighteenth century scientists, Alexander von Humboldt. This article interrogates how Williams makes use of translation to access areas of knowledge traditionally restricted to men, such as philosophy, politics and science. For this purpose, I will focus on her translations of the work of two leading intellectual figures of the eighteenth century,  Rousseau and Von Humboldt.

Evaluation of the Relative Citation Ratio, a New National Institutes of Health-Supported Bibliometric Measure of Research Productivity, among Academic Radiation Oncologists.

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Rock, Calvin B; Prabhu, Arpan V; Fuller, C David; Thomas, Charles R; Holliday, Emma B

2018-03-01

Publication metrics are useful in evaluating academic faculty for awarding grants, recruitment, and promotion. A new metric, the relative citation ratio (RCR), was recently released by the National Institutes of Health (NIH); however, no benchmark data yet exist. We sought to create benchmark data for physician faculty in academic radiation oncology (RO) and analyze correlations associated with increased academic productivity. Citation database searches were performed for all US radiation oncologists affiliated with academic RO programs. Gender, NIH funding, career duration, academic rank, RCR, and weighted RCR were collected for each faculty. RCR and weighted RCR were calculated and compared between each subgroup of interest. RCR percentiles were also created for reference. A total of 1,299 RO physician faculty members from 75 institutions were included in the analysis. Overall, RO physician were very productive and influential with a mean RCR of 1.57 ± 1.53 SD and median RCR (interquartile range) of 1.32 (0.87-1.94). Academic rank, career duration, and NIH funding were associated with increased mean RCR and weighted RCR. Male gender and having a PhD were associated with an increased weighted RCR but not an increased mean RCR. Current academic radiation oncologists have a high mean RCR value relative to the benchmark NIH RCR value of 1. All subgroups analyzed had an RCR value above 1 with professor or chair and previous NIH funding having the highest RCR and weighted RCR values overall. These data may be useful for self-evaluation of ROs as well as evaluation of faculty by institutional and departmental leaders. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

A New Perspective on Mount St. Helens - Dramatic Landform Change and Associated Hazards at the Most Active Volcano in the Cascade Range

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Ramsey, David W.; Driedger, Carolyn L.; Schilling, Steve P.

2008-01-01

Mount St. Helens has erupted more frequently than any other volcano in the Cascade Range during the past 4,000 years. The volcano has exhibited a variety of eruption styles?explosive eruptions of pumice and ash, slow but continuous extrusions of viscous lava, and eruptions of fluid lava. Evidence of the volcano?s older eruptions is recorded in the rocks that build and the deposits that flank the mountain. Eruptions at Mount St. Helens over the past three decades serve as reminders of the powerful geologic forces that are reshaping the landscape of the Pacific Northwest. On May 18, 1980, a massive landslide and catastrophic explosive eruption tore away 2.7 cubic kilometers of the mountain and opened a gaping, north-facing crater. Lahars flowed more than 120 kilometers downstream, destroying bridges, roads, and buildings. Ash from the eruption fell as far away as western South Dakota. Reconstruction of the volcano began almost immediately. Between 1980 and 1986, 80 million cubic meters of viscous lava extruded episodically onto the crater floor, sometimes accompanied by minor explosions and small lahars. A lava dome grew to a height of 267 meters, taller than the highest buildings in the nearby city of Portland, Oregon. Crater Glacier formed in the deeply shaded niche between the 1980-86 lava dome and the south crater wall. Its tongues of ice flowed around the east and west sides of the dome. Between 1989 and 1991, multiple explosions of steam and ash rocked the volcano, possibly a result of infiltrating rainfall being heated in the still-hot interior of the dome and underlying crater floor. In September 2004, rising magma caused earthquake swarms and deformation of the crater floor and glacier, which indicated that Mount St. Helens might erupt again soon. On October 1, 2004, a steam and ash explosion signaled the beginning of a new phase of eruptive activity at the volcano. On October 11, hot rock reached the surface and began building a new lava dome immediately

Finding peace from Hiroshima. One oncologist's fight to rectify the damage caused by radiation

International Nuclear Information System (INIS)

Skoufalos, M.N.

2006-01-01

The article informs about one oncologist's fight to rectify the damage caused by radiation. In a small town just outside Osaka, Japan, Ritsuko Komaki was born, quite literally, into the atomic age. She was just an infant in 1945 when the first atomic bomb ever detonated on a human population devastated her family's ancestral home of Hiroshima. One of her friends, Sasaki was diagnosed with leukemia, and was later hospitalized with bone marrow suppression. Her grandmother had been exposed to the same chemical radiation that Sasaki had, yet never contracted leukemia despite presenting with all the other side effects of exposure. Komaki wa wondering why her grandmother never had any leukemia, but Sadako did? She never had any cancer, but she had all the symptoms of exposure, e.g. hair loss, diarrhea and bone marrow problems. During medical school, Komaki volunteered her summers at the Atomic Bomb Casualty Commission, the institute the United States built in Japan to examine the victims of atomic exposure. Anyone diagnosed as anemic underwent a bone marrow exam, and Komaki learned a great deal about chromosomal abnormalities by performing blood tests alongside visiting researchers from Yale University and other American hospitals. The bombings of Hiroshima and Nagasaki had fostered a national paranoia about radiation and radioactivity. In Japan, they hate radiation, and for so many years, they did not want to hear about radiation therapy. Patients had an illogical fear of it that delayed offering it as treatment there. In Japan, the majority of cancer treatment culminated in surgery. Radiation oncology was not a recognized specialization; oncologists were grouped in with diagnostic radiation techs. Yet today, Ritsuko Komaki, MD, is the chief operating officer of one of the most sophisticated radiation oncology treatment facilities in the United States: the 120 million US Dollar M.D. Anderson Cancer Center in Houston. And ironically, the technical equipment that forms

A worldview of the professional experiences and training needs of pediatric psycho-oncologists

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Oppenheim, Daniel; Breyer, Joanna; Battles, Haven; Zadeh, Sima; Patenaude, Andrea Farkas

2012-01-01

BACKGROUND Thirty years after the origin of the field of psycho-oncology, limited data exist about the work practices of professionals providing psychosocial care to children with cancer and their families. METHOD A survey was designed to assess training, work environment, theoretical orientation, services provided, sub-specialty areas or areas of special interest, satisfactions, challenges and continuing education needs of pediatric psycho-oncologists. Members of national and international psycho-oncology organizations were invited to participate in the web-based survey. RESULTS 786 professionals from 63 countries responded. The sample consisted mostly of psychologists (41%), physicians (20%), and social workers (14%). Approximately half of the participants worked in a designated psycho-oncology unit. Psychologists and social workers provided the majority of psychosocial services. Individual sessions with parents were most common (42%), followed by sessions with children (41%), survivors (36%), families (31%) and siblings (25%). Therapies provided include CBT (50%), relaxation (43%), psychodynamic psychotherapy (27%), play therapy (26%), and imagery (23%). Two-thirds report having appropriate supervision; 37% conduct research; only half feel their salary is appropriate. Differences in therapeutic modalities were found by country. Clinicians desire training on clinical interventions, improving communication with medical staff, research and ethics. CONCLUSIONS An international cohort of clinicians providing pediatric psycho-oncology services perform a wide variety of tasks, use a range of therapeutic approaches and report considerable work satisfaction. Problem areas include professional inter-relations, inadequate supervision and needs for additional, specialized training. Opportunity exists for global collaboration in pediatric psycho-oncology research and practices to enhance clinical effectiveness and reduce professional isolation. PMID:22461180

Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center

Directory of Open Access Journals (Sweden)

D. M. Hansra

2018-01-01

Full Text Available Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P≤0.05. Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.

The source of infrasound associated with long-period events at mount St. Helens

Science.gov (United States)

Matoza, R.S.; Garces, M.A.; Chouet, B.A.; D'Auria, L.; Hedlin, M.A.H.; De Groot-Hedlin, C.; Waite, G.P.

2009-01-01

During the early stages of the 2004-2008 Mount St. Helens eruption, the source process that produced a sustained sequence of repetitive long-period (LP) seismic events also produced impulsive broadband infrasonic signals in the atmosphere. To assess whether the signals could be generated simply by seismic-acoustic coupling from the shallow LP events, we perform finite difference simulation of the seismo-acoustic wavefield using a single numerical scheme for the elastic ground and atmosphere. The effects of topography, velocity structure, wind, and source configuration are considered. The simulations show that a shallow source buried in a homogeneous elastic solid produces a complex wave train in the atmosphere consisting of P/SV and Rayleigh wave energy converted locally along the propagation path, and acoustic energy originating from , the source epicenter. Although the horizontal acoustic velocity of the latter is consistent with our data, the modeled amplitude ratios of pressure to vertical seismic velocity are too low in comparison with observations, and the characteristic differences in seismic and acoustic waveforms and spectra cannot be reproduced from a common point source. The observations therefore require a more complex source process in which the infrasonic signals are a record of only the broadband pressure excitation mechanism of the seismic LP events. The observations and numerical results can be explained by a model involving the repeated rapid pressure loss from a hydrothermal crack by venting into a shallow layer of loosely consolidated, highly permeable material. Heating by magmatic activity causes pressure to rise, periodically reaching the pressure threshold for rupture of the "valve" sealing the crack. Sudden opening of the valve generates the broadband infrasonic signal and simultaneously triggers the collapse of the crack, initiating resonance of the remaining fluid. Subtle waveform and amplitude variability of the infrasonic signals as

A survey of the educational environment for oncologists as perceived by surgical oncology professionals in India

Directory of Open Access Journals (Sweden)

Are Chandrakanth

2012-01-01

Full Text Available Abstract Background The current educational environment may need enhancement to tackle the rising cancer burden in India. The aim of this study was to conduct a survey of Surgical Oncologists to identify their perceptions of the current state of Oncology education in India. Methods An Institutional Review Board approved questionnaire was developed to target the audience of the 2009 annual meeting of the Indian Association of Surgical Oncology in India. The survey collected demographic information and asked respondents to provide their opinions about Oncology education in India. Results A total of 205 out of 408 attendee's participated in the survey with a 42.7% response rate. The majority of respondents felt that Oncology education was poor to fair during medical school (75%, residency (56% and for practicing physicians (71%. The majority of participants also felt that the quality of continuing medical education was poor and that minimal emphasis was placed on evidence based medicine. Conclusions The results of our survey demonstrate that the majority of respondents feel that the current educational environment for Oncology in India should be enhanced. The study identified perceptions of several gaps and needs, which can be the targets for implementing measures to enhance the training of Oncology professionals.

A worldview of the professional experiences and training needs of pediatric psycho-oncologists.

Science.gov (United States)

Wiener, Lori; Oppenheim, Daniel; Breyer, Joanna; Battles, Haven; Zadeh, Sima; Patenaude, Andrea Farkas

2012-09-01

Thirty years after the origin of the field of psycho-oncology, limited data exist about the work practices of professionals providing psychosocial care to children with cancer and their families. A survey was designed to assess training, work environment, theoretical orientation, services provided, subspecialty areas or areas of special interest, satisfactions, challenges, and continuing education needs of pediatric psycho-oncologists. Members of national and international psycho-oncology organizations were invited to participate in the web-based survey. Seven hundred eighty-six professionals from 63 countries responded. The sample consisted mostly of psychologists (41%), physicians (20%), and social workers (14%). Approximately half of the participants worked in a designated psycho-oncology unit. Psychologists and social workers provided the majority of psychosocial services. Individual sessions with parents were most common (42%), followed by sessions with children (41%), survivors (36%), families (31%), and siblings (25%). Therapies provided include cognitive behavioral therapy (50%), relaxation (43%), psychodynamic psychotherapy (27%), play therapy (26%), and imagery (23%). Two-thirds reported having appropriate supervision, 37% were conducting research, and only half felt their salary was appropriate. Differences in therapeutic modalities were found by country. Clinicians desire training on clinical interventions, improving communication with medical staff, research, and ethics. An international cohort of clinicians providing pediatric psycho-oncology services perform a wide variety of tasks, use a range of therapeutic approaches, and report considerable work satisfaction. Problem areas include professional inter-relations, inadequate supervision, and need for additional specialized training. Opportunity exists for global collaboration in pediatric psycho-oncology research and practices to enhance clinical effectiveness and reduce professional isolation

Treatment challenges for community oncologists treating postmenopausal women with endocrine-resistant, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer

International Nuclear Information System (INIS)

Gradishar, William J

2016-01-01

Community-based oncologists are faced with challenges and opportunities when delivering quality patient care, including high patient volumes and diminished resources; however, there may be the potential to deliver increased patient education and subsequently improve outcomes. This review discusses the treatment of postmenopausal women with endocrine-resistant, hormone receptor-positive, human epidermal growth factor receptor 2- negative advanced breast cancer in order to illustrate considerations in the provision of pertinent quality education in the treatment of these patients and the management of therapy-related adverse events. An overview of endocrine-resistant breast cancer and subsequent treatment challenges is also provided. Approved treatment options for endocrine-resistant breast cancer include hormonal therapies and mammalian target of rapamycin inhibitors. Compounds under clinical investigation are also discussed

Burnout among psychosocial oncologists: an application and extension of the effort–reward imbalance model

Science.gov (United States)

Rasmussen, Victoria; Turnell, Adrienne; Butow, Phyllis; Juraskova, Ilona; Kirsten, Laura; Wiener, Lori; Patenaude, Andrea; Hoekstra-Weebers, Josette; Grassi, Luigi

2016-01-01

Objectives Burnout is a significant problem among healthcare professionals working within the oncology setting. This study aimed to investigate predictors of emotional exhaustion (EE) and depersonalisation (DP) in psychosocial oncologists, through the application of the effort–reward imbalance (ERI) model with an additional focus on the role of meaningful work in the burnout process. Methods Psychosocial oncology clinicians (n = 417) in direct patient contact who were proficient in English were recruited from 10 international psychosocial oncology societies. Participants completed an online questionnaire, which included measures of demographic and work characteristics, EE and DP subscales of the Maslach Burnout Inventory-Human Services Survey, the Short Version ERI Questionnaire and the Work and Meaning Inventory. Results Higher effort and lower reward were both significantly associated with greater EE, although not DP. The interaction of higher effort and lower reward did not predict greater EE or DP. Overcommitment predicted both EE and DP but did not moderate the impact of effort and reward on burnout. Overall, the ERI model accounted for 33% of the variance in EE. Meaningful work significantly predicted both EE and DP but accounted for only 2% more of the variance in EE above and beyond the ERI model. Conclusions The ERI was only partially supported as a useful framework for investigating burnout in psychosocial oncology professionals. Meaningful work may be a viable extension of the ERI model. Burnout among health professionals may be reduced by interventions aimed at increasing self-efficacy and changes to the supportive work environment. PMID:26239424

German S3 guideline for renal cell carcinoma. Presentation and discussion of essential aspects for the radiation oncologist

International Nuclear Information System (INIS)

Mueller, Arndt-Christian; Oorschot, Birgitt van; Micke, Oliver; Guckenberger, Matthias

2018-01-01

We aim to introduce and discuss the statements and recommendations of the German S3 guideline on renal cell cancer for daily practice of radiation oncologists. This report comprises indication, treatment decision, dose prescription and current literature including treatment of oligometastatic disease. According to different stages of the disease and the structure of the guideline we focus on five treatment situations and recommendations for decision making: (1) Neo-/adjuvant treatment before or after nephrectomy: No indication for radiotherapy. (2) Small renal mass: Stereotactic ablative radiotherapy is currently seen as experimental option due to small patient numbers reported in the literature. However, local tumor control achieved by SBRT appears favourable with >90% at 2 years. (3) Oligometastasis: Radiation treatment with higher local doses or stereotactic treatment is possible after interdisciplinary discussion. Indications for palliative (4) and symptomatic treatment (5) are not different compared to other tumor entities. Currently, there is no evidence-based indication for radiation treatment in the primary setting (adjuvant/neoadjuvant or definitive) of renal cell cancer. In the future stereotactic radiotherapy should have a stronger role in the treatment of medically inoperable patients with primary renal cell cancer and especially in the setting of oligometastasis. (orig.) [de

New perspective in high tech radiotherapy planning using PET/CT images (Radiation oncologist's view on PET/CT usage)

International Nuclear Information System (INIS)

Hadjieva, T.; Bildirev, N.; Koleva, I.; Zahariev, Z.; Vasileva, V.; Encheva, E.; Sultanov, B.

2010-01-01

Biological images provided by 18F-FDG PET in combination with structural X ray picture currently offer the most accurate available information on tumour staging, curative antitumour effect for prognosis, impairment of organ function after treatment, as well as primary tumour detection in unknown primary metastatic disease. The authors as radiation oncologists critically have analyzed numerous clinical trials and two guidelines to prove PET/ CT benefit in radiotherapy practice. At present they found lack of scientific evidence to confirm that patient outcomes are superior as a result of the use of PET in RT planning. PET/CT offers a best image for tumour delineation only in some cases of lung cancer, mediastinal lymph nodes and malignant lymphomas. 11C methionin PET adds additional information on postoperative MRI image for brain tumours. Inflammation as postradiation phenomenon, as well as physiological organ movements leads to false-positive PET signal. High tech radiotherapy methods require delineation on precise images given after multidisciplinary team expertise - a practice that is possible only in clinical trials, These unsolved problems have raised many ethical challenges in medical, scientific and social aspect, if wide and routine use of FDG-PET u PET/CT is advocated. (authors)

Women with breast cancer report substantially more disease- and treatment-related side or late effects than registered by clinical oncologists: a cross-sectional study of a standard follow-up program in an oncological department

DEFF Research Database (Denmark)

Ellegaard, Mai Britt Bjørklund; Grau, Cai; Zachariae, Robert

2017-01-01

effects were hot flushes (35%), fatigue (32%), and sleep disturbance (31%). CONCLUSION: None of the scheduled or additional visits resulted in detection of recurrent disease. Furthermore, the majority of patients reported side or late effects. Statistically significant more women reported side or late...... effects than registered by the clinical oncologists. This suggests the need for rethinking of the follow-up programs with more emphasis upon side or late effects of the treatment....

Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists.

Science.gov (United States)

Munshi, Anusheel; Dutta, Debanarayan; Tike, Pramod; Agarwal, Jai Prakash

2016-01-01

Obtain baseline data of cell-phone usage in the medical (MO), surgical (SO) and radiation (RO) oncology community practicing in India. Indigenously prepared cell-phone usage related questionnaire was used in the present study after approval by the Institutional Ethics/Scientific Committees. The questionnaire had 41 items and was made to assess the cell-phone usage parameters, utility in clinical practice, awareness, and to compare parameters between oncology specialties. Between November 2009 and January 2010, the questionnaire was sent as an E-mail attachment to 200 oncologists in India. In all, 123 responses were received (61% responders); 84 (68.3%) were RO. The median age of responders was 35 years. Overall, 80% felt handicapped without cell-phone. The Mean cell-phone score, an index to assess overall usefulness over a score of 1-10, was 6.46 (median 7, standard deviation 1.709). There was no significant difference between RO, MO and SO in duration of usage (P = 0.235), number of cell-phones (P = 0.496), call duration per day (P = 0.490) and dependence on cell-phone (P = 0.574). Age of starting cell-phone usage was earlier in RO (P = 0.086). Professional usage was significantly more by MO and SO compared to RO (P cell-phone hazards compared to RO (P cell-phones a useful tool in patient care. More RO are aware of potential cell-phone hazards compared to non-RO's.

Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

Energy Technology Data Exchange (ETDEWEB)

Giuliani, Meredith E., E-mail: Meredith.Giuliani@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Gillan, Caitlin [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Milne, Robin A. [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Uchino, Minako; Millar, Barbara-Ann; Catton, Pamela [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

2014-03-15

Purpose: Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. Methods and Materials: A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. Results: Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). Conclusions: We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.

Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

International Nuclear Information System (INIS)

Giuliani, Meredith E.; Gillan, Caitlin; Milne, Robin A.; Uchino, Minako; Millar, Barbara-Ann; Catton, Pamela

2014-01-01

Purpose: Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. Methods and Materials: A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. Results: Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). Conclusions: We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs

Identifying Health Information Technology Needs of Oncologists to Facilitate the Adoption of Genomic Medicine: Recommendations From the 2016 American Society of Clinical Oncology Omics and Precision Oncology Workshop.

Science.gov (United States)

Hughes, Kevin S; Ambinder, Edward P; Hess, Gregory P; Yu, Peter Paul; Bernstam, Elmer V; Routbort, Mark J; Clemenceau, Jean Rene; Hamm, John T; Febbo, Phillip G; Domchek, Susan M; Chen, James L; Warner, Jeremy L

2017-09-20

At the ASCO Data Standards and Interoperability Summit held in May 2016, it was unanimously decided that four areas of current oncology clinical practice have serious, unmet health information technology needs. The following areas of need were identified: 1) omics and precision oncology, 2) advancing interoperability, 3) patient engagement, and 4) value-based oncology. To begin to address these issues, ASCO convened two complementary workshops: the Omics and Precision Oncology Workshop in October 2016 and the Advancing Interoperability Workshop in December 2016. A common goal was to address the complexity, enormity, and rapidly changing nature of genomic information, which existing electronic health records are ill equipped to manage. The subject matter experts invited to the Omics and Precision Oncology Workgroup were tasked with the responsibility of determining a specific, limited need that could be addressed by a software application (app) in the short-term future, using currently available genomic knowledge bases. Hence, the scope of this workshop was to determine the basic functionality of one app that could serve as a test case for app development. The goal of the second workshop, described separately, was to identify the specifications for such an app. This approach was chosen both to facilitate the development of a useful app and to help ASCO and oncologists better understand the mechanics, difficulties, and gaps in genomic clinical decision support tool development. In this article, we discuss the key challenges and recommendations identified by the workshop participants. Our hope is to narrow the gap between the practicing oncologist and ongoing national efforts to provide precision oncology and value-based care to cancer patients.

Bayesian inversion of data from effusive volcanic eruptions using physics-based models: Application to Mount St. Helens 2004--2008

Science.gov (United States)

Anderson, Kyle; Segall, Paul

2013-01-01

Physics-based models of volcanic eruptions can directly link magmatic processes with diverse, time-varying geophysical observations, and when used in an inverse procedure make it possible to bring all available information to bear on estimating properties of the volcanic system. We develop a technique for inverting geodetic, extrusive flux, and other types of data using a physics-based model of an effusive silicic volcanic eruption to estimate the geometry, pressure, depth, and volatile content of a magma chamber, and properties of the conduit linking the chamber to the surface. A Bayesian inverse formulation makes it possible to easily incorporate independent information into the inversion, such as petrologic estimates of melt water content, and yields probabilistic estimates for model parameters and other properties of the volcano. Probability distributions are sampled using a Markov-Chain Monte Carlo algorithm. We apply the technique using GPS and extrusion data from the 2004–2008 eruption of Mount St. Helens. In contrast to more traditional inversions such as those involving geodetic data alone in combination with kinematic forward models, this technique is able to provide constraint on properties of the magma, including its volatile content, and on the absolute volume and pressure of the magma chamber. Results suggest a large chamber of >40 km3 with a centroid depth of 11–18 km and a dissolved water content at the top of the chamber of 2.6–4.9 wt%.

Methane production and oxidation in lakes impacted by the May 18, 1980 eruption of Mount St. Helens

International Nuclear Information System (INIS)

Lilley, M.D.; Baross, J.A.; Dahm, C.N.

1988-01-01

The concentrations of CH 4 and CH 4 oxidation rates were measured in lakes impacted by the May 18, 1980 eruption of Mount St. Helens. The highest CH 4 concentrations were recorded during the first summer after the eruption and ranged in surface waters from 5 microM in the moderately impacted Ryan Lake to 28 microM in the heavily impacted North Coldwater Lake. At depths below the oxic/anoxic interface, CH 4 levels reached 250 microM in North Coldwater Lake, 184 microM in Spirit Lake, 70 microM in Castle Creek lake, and 60 microM in Ryan Lake. The CH 4 flux measurements from these lakes during the summer following the May 18, 1980 eruption were the highest ever recorded in lakes with ranges of 1.1-2.9 mmol CH 4 /sq m/day in the light to moderately impacted McBride and Ryan Lakes to ranges of 17.4-25.3 mmol CH 4 /sq m/day in the heavily impacted Castle Creek, North Coldwater, and Spirit Lakes. Evidence of CH 4 oxidation was seen in all of the lakes during the summer of 1981, and rates of CH 4 oxidation using C 14 -CH 4 were measured in spirit Lake from 1982 to 1986. The highest rates of CH 4 oxidation measured were during the summer stratification and ranged from 50 to 150 nmol CH 4 oxidized/L/day. methane oxidation rates were measured in waters having oxygen concentrations less than 100 microM with highest activity occurring at concentrations of 30-60 microM. 36 refs., 12 figs. 3 tabs

Oncologists' Experiences and Attitudes About Their Role in Philanthropy and Soliciting Donations From Grateful Patients.

Science.gov (United States)

Walter, Jennifer K; Griffith, Kent A; Jagsi, Reshma

2015-11-10

Physician participation in philanthropy is important to marshal resources that allow hospitals to pursue their missions, but little is known about how physicians participate and their attitudes toward participation. To characterize philanthropic roles physicians play and their attitudes about participation and its ethical acceptability, medical oncologists affiliated with the 40 National Cancer Institute-designated comprehensive cancer centers were randomly sampled and surveyed to evaluate experiences and attitudes regarding participation in philanthropy at their institutions. Responses were tabulated; significant associations by physicians' characteristics were explored. A total of 405 (52%) physicians responded; 62% were men, and 72% were white. Most (71%) had been exposed to their institution's fundraising/development staff; 48% of those were taught how to identify patients who would be good donors; 26% received information about ethical guidelines for soliciting donations from their patients; 21% were taught how their institution ensures Health Insurance Portability and Accountability Act compliance. A third (32%) of respondents had been asked to directly solicit a donation from their patients for their institution, of whom half declined to do so. Those who had solicited from their patients had been in practice significantly longer (mean, 19 v 13 years; P donation (men more than women, 43% v 26%; P = .008); however, 74% agreed it could interfere with the physician-patient relationship, and 52% believe conflict of interest exists. Institutions are asking physicians to directly solicit their patients for donations with variability in physicians' perceptions of the impact on relationships with patients and responses toward those requests. © 2015 by American Society of Clinical Oncology.

[German S3 guideline for renal cell carcinoma : Presentation and discussion of essential aspects for the radiation oncologist].

Science.gov (United States)

Müller, Arndt-Christian; van Oorschot, Birgitt; Micke, Oliver; Guckenberger, Matthias

2018-01-01

We aim to introduce and discuss the statements and recommendations of the German S3 guideline on renal cell cancer for daily practice of radiation oncologists. This report comprises indication, treatment decision, dose prescription and current literature including treatment of oligometastatic disease. According to different stages of the disease and the structure of the guideline we focus on five treatment situations and recommendations for decision making: (1) Neo-/adjuvant treatment before or after nephrectomy: No indication for radiotherapy. (2) Small renal mass: Stereotactic ablative radiotherapy is currently seen as experimental option due to small patient numbers reported in the literature. However, local tumor control achieved by SBRT appears favourable with >90% at 2 years. (3) Oligometastasis: Radiation treatment with higher local doses or stereotactic treatment is possible after interdisciplinary discussion. Indications for palliative (4) and symptomatic treatment (5) are not different compared to other tumor entities. Currently, there is no evidence-based indication for radiation treatment in the primary setting (adjuvant/neoadjuvant or definitive) of renal cell cancer. In the future stereotactic radiotherapy should have a stronger role in the treatment of medically inoperable patients with primary renal cell cancer and especially in the setting of oligometastasis.

Changes in seismic velocity during the first 14 months of the 2004–2008 eruption of Mount St. Helens, Washington

Science.gov (United States)

Hotovec-Ellis, A.J.; Vidale, J.E.; Gomberg, Joan S.; Thelen, Weston A.; Moran, Seth C.

2015-01-01

Mount St. Helens began erupting in late 2004 following an 18 year quiescence. Swarms of repeating earthquakes accompanied the extrusion of a mostly solid dacite dome over the next 4 years. In some cases the waveforms from these earthquakes evolved slowly, likely reflecting changes in the properties of the volcano that affect seismic wave propagation. We use coda-wave interferometry to quantify small changes in seismic velocity structure (usually <1%) between two similar earthquakes and employed waveforms from several hundred families of repeating earthquakes together to create a continuous function of velocity change observed at permanent stations operated within 20 km of the volcano. The high rate of earthquakes allowed tracking of velocity changes on an hourly time scale. Changes in velocity were largest near the newly extruding dome and likely related to shallow deformation as magma first worked its way to the surface. We found strong correlation between velocity changes and the inverse of real-time seismic amplitude measurements during the first 3 weeks of activity, suggesting that fluctuations of pressure in the shallow subsurface may have driven both seismicity and velocity changes. Velocity changes during the remainder of the eruption likely result from a complex interplay of multiple effects and are not well explained by any single factor alone, highlighting the need for complementary geophysical data when interpreting velocity changes.

Self-similar rupture implied by scaling properties of volcanic earthquakes occurring during the 2004-2008 eruption of Mount St. Helens, Washington

Science.gov (United States)

Harrington, Rebecca M.; Kwiatek, Grzegorz; Moran, Seth C.

2015-01-01

We analyze a group of 6073 low-frequency earthquakes recorded during a week-long temporary deployment of broadband seismometers at distances of less than 3 km from the crater at Mount St. Helens in September of 2006. We estimate the seismic moment (M0) and spectral corner frequency (f0) using a spectral ratio approach for events with a high signal-to-noise (SNR) ratio that have a cross-correlation coefficient of 0.8 or greater with at least five other events. A cluster analysis of cross-correlation values indicates that the group of 421 events meeting the SNR and cross-correlation criteria forms eight event families that exhibit largely self-similar scaling. We estimate the M0 and f0 values of the 421 events and calculate their static stress drop and scaled energy (ER/M0) values. The estimated values suggest self-similar scaling within families, as well as between five of eight families (i.e.,  and  constant). We speculate that differences in scaled energy values for the two families with variable scaling may result from a lack of resolution in the velocity model. The observation of self-similar scaling is the first of its kind for such a large group of low-frequency volcanic tectonic events occurring during a single active dome extrusion eruption.

WE-D-204-01: Site-Specific Clinical Rotation: Into the Minds of the Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

Hendrickson, K. [University of Washington (United States)

2016-06-15

Speakers in this session will present overview and details of a specific rotation or feature of their Medical Physics Residency Program that is particularly exceptional and noteworthy. The featured rotations include foundational topics executed with exceptional acumen and innovative educational rotations perhaps not commonly found in Medical Physics Residency Programs. A site-specific clinical rotation will be described, where the medical physics resident follows the physician and medical resident for two weeks into patient consultations, simulation sessions, target contouring sessions, planning meetings with dosimetry, patient follow up visits, and tumor boards, to gain insight into the thought processes of the radiation oncologist. An incident learning rotation will be described where the residents learns about and practices evaluating clinical errors and investigates process improvements for the clinic. The residency environment at a Canadian medical physics residency program will be described, where the training and interactions with radiation oncology residents is integrated. And the first month rotation will be described, where the medical physics resident rotates through the clinical areas including simulation, dosimetry, and treatment units, gaining an overview of the clinical flow and meeting all the clinical staff to begin the residency program. This session will be of particular interest to residency programs who are interested in adopting or adapting these curricular ideas into their programs and to residency candidates who want to learn about programs already employing innovative practices. Learning Objectives: To learn about exceptional and innovative clinical rotations or program features within existing Medical Physics Residency Programs. To understand how to adopt/adapt innovative curricular designs into your own Medical Physics Residency Program, if appropriate.

WE-D-204-01: Site-Specific Clinical Rotation: Into the Minds of the Radiation Oncologists

International Nuclear Information System (INIS)

Hendrickson, K.

2016-01-01

Speakers in this session will present overview and details of a specific rotation or feature of their Medical Physics Residency Program that is particularly exceptional and noteworthy. The featured rotations include foundational topics executed with exceptional acumen and innovative educational rotations perhaps not commonly found in Medical Physics Residency Programs. A site-specific clinical rotation will be described, where the medical physics resident follows the physician and medical resident for two weeks into patient consultations, simulation sessions, target contouring sessions, planning meetings with dosimetry, patient follow up visits, and tumor boards, to gain insight into the thought processes of the radiation oncologist. An incident learning rotation will be described where the residents learns about and practices evaluating clinical errors and investigates process improvements for the clinic. The residency environment at a Canadian medical physics residency program will be described, where the training and interactions with radiation oncology residents is integrated. And the first month rotation will be described, where the medical physics resident rotates through the clinical areas including simulation, dosimetry, and treatment units, gaining an overview of the clinical flow and meeting all the clinical staff to begin the residency program. This session will be of particular interest to residency programs who are interested in adopting or adapting these curricular ideas into their programs and to residency candidates who want to learn about programs already employing innovative practices. Learning Objectives: To learn about exceptional and innovative clinical rotations or program features within existing Medical Physics Residency Programs. To understand how to adopt/adapt innovative curricular designs into your own Medical Physics Residency Program, if appropriate.

Liftoff of the 18 May 1980 surge of Mount St. Helens (USA) and the deposits left behind

Science.gov (United States)

Gardner, James E.; Andrews, Benjamin J.; Dennen, Robert

2017-01-01

The distance that ground-hugging pyroclastic density currents travel is limited partly by when they reverse buoyancy and liftoff into the atmosphere. It is not clear, however, what deposits are left behind by lofting flows. One current that was seen to liftoff was the surge erupted from Mount St. Helens on the morning of 18 May 1980. Before lofting, it had leveled a large area of thick forest (the blowdown zone). The outer edge of the devastated area—where trees were scorched but left standing (the scorched zone)—is where the surge is thought to have lifted off. Deposits in the outer parts of the blowdown and in the scorched zone were examined at 32 sites. The important finding is that the laterally moving surge traveled through the scorched zone, and hence, the change in tree damage does not mark the runout distance of the surge. Buoyancy reversal and liftoff are thus not preserved in the deposits where the surge lofted upwards. We propose, based on interpretation of eyewitness accounts and the impacts of the surge on trees and vehicles, that the surge consisted of a faster, dilute "overcurrent" and a slower "undercurrent," where most of the mass (and heat) was retained. Reasonable estimates for flow density and velocity show that dynamic pressure of the surge (i.e., its ability to topple trees) peaked near the base of the overcurrent. We propose that where the overcurrent began to liftoff, the height of peak dynamic pressure rose above the trees and stopped toppling them. The slower undercurrent continued forward, however, scorching trees, but lacked the dynamic pressure needed to topple them. Grain-size variations argue that it slowed from ˜30 m s-1 when it entered the scorched zone to ˜3 m s-1 at the far end.

Monitoring lava-dome growth during the 2004-2008 Mount St. Helens, Washington, eruption using oblique terrestrial photography

Science.gov (United States)

Major, J.J.; Dzurisin, D.; Schilling, S.P.; Poland, Michael P.

2009-01-01

We present an analysis of lava dome growth during the 2004–2008 eruption of Mount St. Helens using oblique terrestrial images from a network of remotely placed cameras. This underutilized monitoring tool augmented more traditional monitoring techniques, and was used to provide a robust assessment of the nature, pace, and state of the eruption and to quantify the kinematics of dome growth. Eruption monitoring using terrestrial photography began with a single camera deployed at the mouth of the volcano's crater during the first year of activity. Analysis of those images indicates that the average lineal extrusion rate decayed approximately logarithmically from about 8 m/d to about 2 m/d (± 2 m/d) from November 2004 through December 2005, and suggests that the extrusion rate fluctuated on time scales of days to weeks. From May 2006 through September 2007, imagery from multiple cameras deployed around the volcano allowed determination of 3-dimensional motion across the dome complex. Analysis of the multi-camera imagery shows spatially differential, but remarkably steady to gradually slowing, motion, from about 1–2 m/d from May through October 2006, to about 0.2–1.0 m/d from May through September 2007. In contrast to the fluctuations in lineal extrusion rate documented during the first year of eruption, dome motion from May 2006 through September 2007 was monotonic (± 0.10 m/d) to gradually slowing on time scales of weeks to months. The ability to measure spatial and temporal rates of motion of the effusing lava dome from oblique terrestrial photographs provided a significant, and sometimes the sole, means of identifying and quantifying dome growth during the eruption, and it demonstrates the utility of using frequent, long-term terrestrial photography to monitor and study volcanic eruptions.

Volcanic tremor masks its seismogenic source: Results from a study of noneruptive tremor recorded at Mount St. Helens, Washington

Science.gov (United States)

Denlinger, Roger P.; Moran, Seth C.

2014-01-01

On 2 October 2004, a significant noneruptive tremor episode occurred during the buildup to the 2004–2008 eruption of Mount St. Helens (Washington). This episode was remarkable both because no explosion followed, and because seismicity abruptly stopped following the episode. This sequence motivated us to consider a model for volcanic tremor that does not involve energetic gas release from magma but does involve movement of conduit magma through extension on its way toward the surface. We found that the tremor signal was composed entirely of Love and Rayleigh waves and that its spectral bandwidth increased and decreased with signal amplitude, with broader bandwidth signals containing both higher and lower frequencies. Our modeling results demonstrate that the forces giving rise to this tremor were largely normal to conduit walls, generating hybrid head waves along conduit walls that are coupled to internally reflected waves. Together these form a crucial part of conduit resonance, giving tremor wavefields that are largely a function of waveguide geometry and velocity. We find that the mechanism of tremor generation fundamentally masks the nature of the seismogenic source giving rise to resonance. Thus multiple models can be invoked to explain volcanic tremor, requiring that information from other sources (such as visual observations, geodesy, geology, and gas geochemistry) be used to constrain source models. With concurrent GPS and field data supporting rapid rise of magma, we infer that tremor resulted from drag of nearly solid magma along rough conduit walls as magma was forced toward the surface.

After the disaster: the hydrogeomorphic, ecological, and biological responses to the 1980 eruption of Mount St. Helens, Washington

Science.gov (United States)

Major, Jon J.; Crisafulli, Charlie; Bishop, John

2009-01-01

The 1980 eruption of Mount St. Helens caused instantaneous landscape disturbance on a grand scale. On 18 May 1980, an ensemble of volcanic processes, including a debris avalanche, a directed pyroclastic density current, voluminous lahars, and widespread tephra fall, abruptly altered landscape hydrology and geomorphology, and created distinctive disturbance zones having varying impacts on regional biota. Response to the geological and ecological disturbances has been varied and complex. In general, eruption-induced alterations in landscape hydrology and geomorphology led to enhanced stormflow discharge and sediment transport. Although the hydrological response to landscape perturbation has diminished, enhanced sediment transport persists in some basins. In the nearly 30 years since the eruption, 350 million (metric) tons of suspended sediment has been delivered from the Toutle River watershed to the Cowlitz River (roughly 40 times the average annual preeruption suspended-sediment discharge of the Columbia River). Such prodigious sediment loading has wreaked considerable socioeconomic havoc, causing significant channel aggradation and loss of flood conveyance capacity. Significant and ongoing engineering efforts have been required to mitigate these problems. The overall biological evolution of the eruption-impacted landscape can be viewed in terms of a framework of survivor legacies. Despite appearances to the contrary, a surprising number of species survived the eruption, even in the most heavily devastated areas. With time, survivor “hotspots” have coalesced into larger patches, and have served as stepping stones for immigrant colonization. The importance of biological legacies will diminish with time, but the intertwined trajectories of geophysical and biological successions will influence the geological and biological responses to the 1980 eruption for decades to come.

Array-Based Receiver Function Analysis of the Subducting Juan de Fuca Plate Beneath the Mount St. Helens Region and its Implications for Subduction Geometry and Metamorphism

Science.gov (United States)

Mann, M. E.; Abers, G. A.; Creager, K. C.; Ulberg, C. W.; Crosbie, K.

2017-12-01

Mount St. Helens (MSH) is unusual as a prolific arc volcano located 50 km towards the forearc of the main Cascade arc. The iMUSH (imaging Magma Under mount St. Helens) broadband deployment featured 70 seismometers at 10-km spacing in a 50-km radius around MSH, spanning a sufficient width for testing along-strike variation in subsurface geometry as well as deep controls on volcanism in the Cascade arc. Previous estimates of the geometry of the subducting Juan de Fuca (JdF) slab are extrapolated to MSH from several hundred km to the north and south. We analyze both P-to-S receiver functions and 2-D Born migrations of the full data set to locate the upper plate Moho and the dip and depth of the subducting slab. The strongest coherent phase off the subducting slab is the primary reverberation (Ppxs; topside P-to-S reflection) from the Moho of the subducting JdF plate, as indicated by its polarity and spatial pattern. Migration images show a dipping low velocity layer at depths less than 50 km that we interpret as the subducting JdF crust. Its disappearance beyond 50 km depth may indicate dehydration of subducting crust or disruption of high fluid pressures along the megathrust. The lower boundary of the low velocity zone, the JdF Moho, persists in the migration image to depths of at least 90 km and is imaged at 74 km beneath MSH, dipping 23 degrees. The slab surface is 68 km beneath MSH and 85 km beneath Mount Adams volcano to the east. The JdF Moho exhibits 10% velocity contrasts as deep as 85 km, an observation difficult to reconcile with simple models of crustal eclogitization. The geometry and thickness of the JdF crust and upper plate Moho is consistent with similar transects of Cascadia and does not vary along strike beneath iMUSH, indicating a continuous slab with no major disruption. The upper plate Moho is clear on the east side of the array but it disappears west of MSH, a feature we interpret as a result of both serpentinization of the mantle wedge and a

Source mechanisms of persistent shallow earthquakes during eruptive and non-eruptive periods between 1981 and 2011 at Mount St. Helens, Washington

Science.gov (United States)

Lehto, Heather L.; Roman, Diana C.; Moran, Seth C.

2013-01-01

Shallow seismicity between 0 and 3-km depth has persisted at Mount St. Helens, Washington (MSH) during both eruptive and non-eruptive periods for at least the past thirty years. In this study we investigate the source mechanisms of shallow volcano-tectonic (VT) earthquakes at MSH by calculating high-quality hypocenter locations and fault plane solutions (FPS) for all VT events recorded during two eruptive periods (1981–1986 and 2004–2008) and two non-eruptive periods (1987–2004 and 2008–2011). FPS show a mixture of normal, reverse, and strike-slip faulting during all periods, with a sharp increase in strike-slip faulting observed in 1987–1997 and an increase in normal faulting in 1998–2004. FPS P-axis orientations show a ~ 90° rotation with respect to regional σ1 (N23°E) during 1981–1986 and 2004–2008, bimodal orientations (~ N-S and ~ E-W) during 1987–2004, and bimodal orientations at ~ N-E and ~ S-W from 2008–2011. We interpret these orientations to likely be due to pressurization accompanying the shallow intrusion and subsequent eruption of magma as domes during 1981–1986 and 2004–2008 and the buildup of pore pressure beneath a seismogenic volume (located at 0–1 km) with a smaller component due to the buildup of tectonic forces during 1987–2004 and 2008–2011.

High-resolution digital elevation model of Mount St. Helens crater and upper North Fork Toutle River basin, Washington, based on an airborne lidar survey of September 2009

Science.gov (United States)

Mosbrucker, Adam

2014-01-01

The lateral blast, debris avalanche, and lahars of the May 18th, 1980, eruption of Mount St. Helens, Washington, dramatically altered the surrounding landscape. Lava domes were extruded during the subsequent eruptive periods of 1980–1986 and 2004–2008. More than three decades after the emplacement of the 1980 debris avalanche, high sediment production persists in the North Fork Toutle River basin, which drains the northern flank of the volcano. Because this sediment increases the risk of flooding to downstream communities on the Toutle and Cowlitz Rivers, the U.S. Army Corps of Engineers (USACE), under the direction of Congress to maintain an authorized level of flood protection, built a sediment retention structure on the North Fork Toutle River in 1989 to help reduce this risk and to prevent sediment from clogging the shipping channel of the Columbia River. From September 16–20, 2009, Watershed Sciences, Inc., under contract to USACE, collected high-precision airborne lidar (light detection and ranging) data that cover 214 square kilometers (83 square miles) of Mount St. Helens and the upper North Fork Toutle River basin from the sediment retention structure to the volcano's crater. These data provide a digital dataset of the ground surface, including beneath forest cover. Such remotely sensed data can be used to develop sediment budgets and models of sediment erosion, transport, and deposition. The U.S. Geological Survey (USGS) used these lidar data to develop digital elevation models (DEMs) of the study area. DEMs are fundamental to monitoring natural hazards and studying volcanic landforms, fluvial and glacial geomorphology, and surface geology. Watershed Sciences, Inc., provided files in the LASer (LAS) format containing laser returns that had been filtered, classified, and georeferenced. The USGS produced a hydro-flattened DEM from ground-classified points at Castle, Coldwater, and Spirit Lakes. Final results averaged about five laser last

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist.

Science.gov (United States)

Lindau, Stacy Tessler; Abramsohn, Emily M; Baron, Shirley R; Florendo, Judith; Haefner, Hope K; Jhingran, Anuja; Kennedy, Vanessa; Krane, Mukta K; Kushner, David M; McComb, Jennifer; Merritt, Diane F; Park, Julie E; Siston, Amy; Straub, Margaret; Streicher, Lauren

2016-05-01

Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society. © 2016 American Cancer Society, Inc.

IAEA Syllabus for the Education and Training of Radiation Oncologists. Endorsed by the American Society for Radiation Oncology (ASTRO) and the European Society for Therapeutic Radiology and Oncology (ESTRO) (Spanish Edition); Programa de estudios y capacitacion del OIEA para la formacion de radiooncologos. Aprobado por la Sociedad Americana de Radioterapia y Oncologia (ASTRO) y la Sociedad Europea de Radioterapia y Oncologia (ESTRO)

Energy Technology Data Exchange (ETDEWEB)

NONE

2014-03-15

Cancer is one of the leading causes of death globally and cancer incidence is predicted to increase, especially in developing countries. Almost 13% of all deaths worldwide are caused by cancer. In 2005, there were more than 7.6 million cancer deaths worldwide and 10 million newly diagnosed cases of cancer. Today there are more new cancer cases every year in lowmiddle income (LMI) countries than in industrialized countries, and cancer rates are projected to increase significantly in developing countries. By 2020, two-thirds of the projected 10 million annual cancer deaths will be in developing countries. Radiotherapy plays a fundamental role in the continuum of cancer care. However, this technology is not comprehensively provided and in some countries not provided at all. According to the IAEA's Directory of Radiotherapy Centers (DIRAC), as of January 2004 there were about 2000 radiotherapy centres in the developing world with fewer than 2500 teletherapy machines dedicated to cancer therapy. The deficit is not just one of machines - each radiotherapy facility needs trained staff (radiation oncologists, medical physicists, technologists, radiation oncology nurses and maintenance engineers) as well as appropriate arrangements for radiation protection, safety, security and a continuing and ongoing effort to ensure the quality of the radiotherapy process. Strengthening the capability of ministries of health and other health sector institutions for assessing options, formulating policies, and setting priorities is also crucial. The International Atomic Energy Agency (IAEA) has been assisting its Member States in the establishment, operation and upgrading of radiation oncology facilities for many years. Human resource development, which includes training of radiation oncologists, medical physicists, radiation therapy technologists and radiation oncology nurses, is an integral part of the assistance as shortage of such trained professionals would be a serious obstacle to

Regional meeting of south Oncologist.Third day of Oncologic nursing; Encuentro regional de Oncologos del sur.3as. Jornadas de enfermería Oncológica

Energy Technology Data Exchange (ETDEWEB)

NONE

2010-12-15

The organization of the Uruguayan Congress represents the greatest effort Oncology Society Medical and Pediatric Uruguay (Sompu) to contribute to the prevention, diagnosis and treatment of cancer in Uruguay. It has developed a program that includes a wide range of topics presenting the latest developments and their significance in clinical practice, through lectures, round tables, and panels-course forum. Selected scientific papers were also discussed sessions for oral and poster presentation way. To ensure a high scientific and educational level to a select group of domestic and foreign experts were invited. The 8th Congress incorporates a panel-led forum for residents and young oncologists Prevention Cancer. Furthermore Course was held on hereditary predispositions to cancer under the Continuing Medical Education Program developed by the Sompu and accredited by the Graduate School. A special meeting in the context of the Latin American Federation of Cancer Societies (FLASCA) Therapeutic Research on Cancer in .In Region Parallel Days also included third Oncology Nursing also developed.

Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists.

Science.gov (United States)

Suneja, Gita; Boyer, Matthew; Yehia, Baligh R; Shiels, Meredith S; Engels, Eric A; Bekelman, Justin E; Long, Judith A

2015-05-01

HIV-infected individuals with non-AIDS-defining cancers are less likely to receive cancer treatment compared with uninfected individuals. We sought to identify provider-level factors influencing the delivery of oncology care to HIV-infected patients. A survey was mailed to 500 randomly selected US medical and radiation oncologists. The primary outcome was delivery of standard treatment, assessed by responses to three specialty-specific management questions. We used the χ(2) test to evaluate associations between delivery of standard treatment, provider demographics, and perceptions of HIV-infected individuals. Multivariable logistic regression identified associations using factor analysis to combine several correlated survey questions. Our response rate was 60%; 69% of respondents felt that available cancer management guidelines were insufficient for the care of HIV-infected patients with cancer; 45% never or rarely discussed their cancer management plan with an HIV specialist; 20% and 15% of providers were not comfortable discussing cancer treatment adverse effects and prognosis with their HIV-infected patients with cancer, respectively; 79% indicated that they would provide standard cancer treatment to HIV-infected patients. In multivariable analysis, physicians comfortable discussing adverse effects and prognosis were more likely to provide standard cancer treatment (adjusted odds ratio, 1.52; 95% CI, 1.12 to 2.07). Physicians with concerns about toxicity and efficacy of treatment were significantly less likely to provide standard cancer treatment (adjusted odds ratio, 0.67; 95% CI, 0.53 to 0.85). Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients. Policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment. Copyright © 2015 by American Society of Clinical Oncology.

American Society for Radiation Oncology (ASTRO) 2012 Workforce Study: The Radiation Oncologists' and Residents' Perspectives

International Nuclear Information System (INIS)

Pohar, Surjeet; Fung, Claire Y.; Hopkins, Shane; Miller, Robert; Azawi, Samar; Arnone, Anna; Patton, Caroline; Olsen, Christine

2013-01-01

Purpose: The American Society for Radiation Oncology (ASTRO) conducted the 2012 Radiation Oncology Workforce Survey to obtain an up-to-date picture of the workforce, assess its needs and concerns, and identify quality and safety improvement opportunities. The results pertaining to radiation oncologists (ROs) and residents (RORs) are presented here. Methods: The ASTRO Workforce Subcommittee, in collaboration with allied radiation oncology professional societies, conducted a survey study in early 2012. An online survey questionnaire was sent to all segments of the radiation oncology workforce. Respondents who were actively working were included in the analysis. This manuscript describes the data for ROs and RORs. Results: A total of 3618 ROs and 568 RORs were surveyed. The response rate for both groups was 29%, with 1047 RO and 165 ROR responses. Among ROs, the 2 most common racial groups were white (80%) and Asian (15%), and the male-to-female ratio was 2.85 (74% male). The median age of ROs was 51. ROs averaged 253.4 new patient consults in a year and 22.9 on-treatment patients. More than 86% of ROs reported being satisfied or very satisfied overall with their career. Close to half of ROs reported having burnout feelings. There was a trend toward more frequent burnout feelings with increasing numbers of new patient consults. ROs' top concerns were related to documentation, reimbursement, and patients' health insurance coverage. Ninety-five percent of ROs felt confident when implementing new technology. Fifty-one percent of ROs thought that the supply of ROs was balanced with demand, and 33% perceived an oversupply. Conclusions: This study provides a current snapshot of the 2012 radiation oncology physician workforce. There was a predominance of whites and men. Job satisfaction level was high. However a substantial fraction of ROs reported burnout feelings. Perceptions about supply and demand balance were mixed. ROs top concerns reflect areas of attention for the

Flow Encountering Abrupt Topography

Science.gov (United States)

2013-09-30

Colin at the Coral Reef Research Foundation and Paul Collins, who has extensive experience with such data). Helen Reef Concerted UCTD measurements...sensors, weights , 45 m of line, and a float) which were arrayed around Helen Reef nominally on the 90-m isobath using Revelle’s workboat. Colin (CRRF...the main islands of Palau and diverts around the south and north ends of the island group (Figure 1, left and right; Section ). At Helen Reef and Toby

"Kuninganna" Tallinnas / Andri Maimets

Index Scriptorium Estoniae

Maimets, Andri, 1979-

2007-01-01

Tänasest on Sõpruse kinos Stephen Frearsi mängufilm "Kuninganna" ("The Queen") : stsenarist Peter Morgan : kuninganna Elizabeth II kehastab Helen Mirren, peaminister Tony Blair'i Michael Sheen. Lisatud andmed Helen Mirreni kohta

Better constraints on the size and volatile content of the Mount St. Helens magma reservoir following the end of the 2004-2008 eruption

Science.gov (United States)

Mastin, L. G.; Lisowski, M.; Beeler, N.; Roeloffs, E.

2008-12-01

The October 2004-January 2008 eruption of Mount St. Helens produced about 93 million cubic meters dense-rock equivalent (DRE) lava at a continuous rate that decreased monotonically from ~6 m3 s-1 to zero over its duration. From late October 2004 through the end of the eruption, continuous GPS stations around the mountain recorded inward deflation at a rate that dropped monotonically below the noise level by early 2007. The geodetic signal is consistent with a volume change Δ Vc of ~16-25M m3 in an ellipsoidal reservoir of volume Vc centered at ~9-14 km depth beneath the crater. Throughout the eruption we used physically based models to extrapolate trends in lava-dome volume and deflation, and to forecast the duration and final erupted volume, Ve, using assumed or geologically constrained values of Vc, average recharge rate R into the reservoir, and compressibilities of magma (Km = ( 1/ρ m )( ∂ ρ m /∂ p )) and of the reservoir (Kc = ( 1/Vc )( ∂ Vc /∂ p )), where ρ m is magma density and p is pressure). Curves that neglected recharge consistently under-predicted both the final duration and volume, while those that assumed a constant recharge rate predicted indefinite duration and volume. The fact that the eruption ended several months after deflation stopped suggests that the long-term average recharge was close to zero, or at least much less than the average eruption rate. The discrepancy between Ve (93M m3) and Δ VC (16-25M m3) can be accounted for by the elastic relation Ve /Δ Vc = ( 1 + Km /Kc ), with Km = 3 - 4 × 10- 10 Pa-1 calculated for reservoir magma with 1- 1.5% bubbles (constrained from gas studies of the erupted lava), and Kc = 1.1 - 1.5 × 10 - 10 Pa-1. Assuming that the pressure drop dp in the reservoir was only slightly greater than the ~5 MPa increase in pressure at the 2004 vent elevation due to growth of the 220-m-high lava dome, the elastic relation Ve = VC dp( Kc + Km ) suggests that the eruption could have been fed by a reservoir

Tants / Eduard Tido, Janika Sarantshina ; interv. Mel Shiffer

Index Scriptorium Estoniae

Tido, Eduard

2007-01-01

Oma harrastusest räägivad hip-hop tantsijad Eduard Tido, Janika Sharantshina, Eva Ottas, show-tantsija Helen Randmäe, club freestyle autor Monika Tuvi, dance hall'i maaletooja Helen Lõhmus ja breikar Marek Vetik

Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer.

Science.gov (United States)

Lipitz-Snyderman, Allison; Kale, Minal; Robbins, Laura; Pfister, David; Fortier, Elizabeth; Pocus, Valerie; Chimonas, Susan; Weingart, Saul N

2017-11-01

Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study's objective was to elicit physicians' perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer. Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists). Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis. Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays. Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

Marketing Authorization Procedures for Advanced Cancer Drugs: Exploring the Views of Patients, Oncologists, Healthcare Decision Makers, and Citizens in France.

Science.gov (United States)

Protiére, Christel; Baker, Rachel; Genre, Dominique; Goncalves, Anthony; Viens, Patrice

2017-07-01

The past decades have seen advances in cancer treatments in terms of toxicity and side effects but progress in the treatment of advanced cancer has been modest. New drugs have emerged improving progression free survival but with little impact on overall survival, raising questions about the criteria on which to base decisions to grant marketing authorizations and about the authorization procedure itself. For decisions to be fair, transparent and accountable, it is necessary to consider the views of those with relevant expertise and experience. We conducted a Q-study to explore the views of a range of stakeholders in France, involving: 54 patients (18 months after diagnosis); 50 members of the general population; 27 oncologists; 19 healthcare decision makers; and 2 individuals from the pharmaceutical industry. Three viewpoints emerged, focussing on different dimensions entitled: 1) 'Quality of life (QoL), opportunity cost and participative democracy'; 2)'QoL and patient-centeredness'; and 3) 'Length of life'. Respondents from all groups were associated with each viewpoint, except for healthcare decision makers, who were only associated with the first one. Our results highlight plurality in the views of stakeholders, emphasize the need for transparency in decision making processes, and illustrate the importance of a re-evaluation of treatments for all 3 viewpoints. In the context of advanced cancer, our results suggest that QoL should be more prominent amongst authorization criteria, as it is a concern for 2 of the 3 viewpoints.

Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

International Nuclear Information System (INIS)

Leong, Cheng Nang; Shakespeare, Thomas Philip; Mukherjee, Rahul K.; Back, Michael F.; Lee, Khai Mun; Lu, Jiade Jay; Wynne, Christopher J.; Lim, Keith; Tang, Johann; Zhang Xiaojian

2006-01-01

Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence

MOOC Blended learning ontwikkelen

NARCIS (Netherlands)

Verjans, Steven

2015-01-01

Presentatie over het ontwerpen van leeractiviteiten (learning design) tijdens de zesde live sessie van de MOOC Blended learning ontwikkelen. Met gebruikmaking van presentatiematerialen van Diana Laurillard, Grainne Conole, Helen Beetham, Jos Fransen, Pieter Swager, Helen Keegan, Corinne Weisgerber.

Assessing New and Old Methods in Paleomagnetic Paleothermometry: A Test Case at Mt. St. Helens, USA

Science.gov (United States)

Bowles, J. A.; Gerzich, D.; Jackson, M. J.

2017-12-01

Paleomagnetic data can be used to estimate deposit temperatures (Tdep) of pyroclastic density currents (PDCs). The typical method is to thermally demagnetize oriented lithic clasts incorporated into the PDC. If Tdep is less than the maximum Curie temperature (Tc), the clast is partially remagnetized in the PDC, and the unblocking temperature (Tub) at which this remagnetization is removed is an estimate of Tdep. In principle, juvenile clasts can also be used, and Tub-max is taken as the minimum Tdep. This all assumes blocking (Tb) and unblocking temperatures are equivalent and that the blocking spectrum remains constant through time. Recent evidence shows that Tc in many titanomagnetites is a strong function of thermal history due to a crystal-chemical reordering process. We therefore undertake a study designed to test some of these assumptions and to assess the extent to which the method may be biased by a Tb spectrum that shifts to higher T during cooling. We also explore a new magnetic technique that relies only on stratigraphic variations in Tc. Samples are from the May 18, 1980 PDCs at Mt. St. Helens, USA. Direct temperature measurements of the deposits were 297 - 367°C. At sites with oriented lithics, standard methods provide a Tdep range that overlaps with measured temperatures, but is systematically higher by a few 10s of °C. By contrast, pumice clasts all give Tdep_min estimates that greatly exceed lithic estimates and measured temperatures. We attribute this overestimate to two causes: 1) Tc and Tub systematically increase with depth as a result of the reordering process. This results in Tdep_min estimates that vary by 50°C and increase with depth. 2) MSH pumice is multi-domain, where Tub > Tb, resulting in a large overestimate in Tdep. At 5 sites, stratigraphic variations in Tc were conservatively interpreted in terms of Tdep as 300°C. More sophisticated modeling of the time-temperature-depth evolution of Tc allows us to place tighter constraints on

The Stars Belong to Everyone: The rhetorical practices of astronomer and science writer Dr. Helen Sawyer Hogg (1905--1993)

Science.gov (United States)

Cahill, Maria J.

Astronomer and science writer Dr. Helen Sawyer Hogg (University of Toronto) reached a variety of audiences through different rhetorical forms. She communicated to her colleagues through her scholarly writings; she reached out to students and the public through her Toronto Star newspaper column entitled "With the Stars," which she authored for thirty years; she wrote The Stars Belong to Everyone , a book that speaks to a lay audience; she hosted a successful television series entitled Ideas ; and she delivered numerous speeches at scientific conferences, professional women's associations, school programs, libraries, and other venues. Adapting technical information for different audiences is at the heart of technical communication, and Sawyer Hogg's work exemplifies adaptation as she moves from writing for the scientific community (as in her articles on globular cluster research) to science writing for lay audiences (as in her newspaper column, book, and script for her television series). Initially she developed her sense of audience through a male perspective informed largely by her scholarly work with two men (Harlow Shapley and her husband, Frank Hogg) as well as the pervasive masculine culture of academic science. This dissertation situates Sawyer Hogg in what is slowly becoming a canon of technical communication scholarship on female scientists. Toward this end, I discuss how she rhetorically engaged two different audiences, one scholarly and one popular, how Sawyer Hogg translated male dominated scientific rhetoric to writing for the public, and how science writing helped her achieve her professional goals. Complementing the archival research in addressing the questions of this study, I employ social construction analysis (also known as the social perspective) for my research methodology. She was ahead of her time and embodied the social perspective years before its definition as a rhetorical concept. In short, my study illuminates one scientific woman's voice

Toward the tailor made therapy for head and neck cancer. From the thinking by surgical oncologist. From bench to clinic, clinic to bench

International Nuclear Information System (INIS)

Ogawa, Tetsuya; Ikeda, Atsuhiko; Nishimura, Kunihiro; Tsuchiya, Yoshimasa; Banno, Shinya; Ueda, Hiromi

2011-01-01

The decision for head and neck cancer treatment is complex and difficult due to the anatomical uniqueness, importance of preserving functions such as speech and swallowing. The selection of surgery, chemotherapy and radiation, is great importance. We apply induction chemotherapy (IC), to select surgery or chemoradiotherapy depending on the response to IC. The purpose of IC is to discover the chemosensitivity of the cancer at the beginning of treatment, and to treat the whole body of distant metastasis in head and neck cancer. We studied the cases of IC followed by daily low dose cisplatin (CDDP) or weekly docetaxel (DOC) chemoradiotherapy (CRT). We found that IC partial response (PR) cases could get high CR rate after completed CRT, but low CR rate in not achieved IC PR cases (p<0.01). We think that for IC PR cases, there are no needs for high dose CDDP CRT. From the basic research by using cell line and protein level comprehensive analysis, we found the new target marker of CDDP resistance. We think that the head and neck surgical oncologist should decide the best treatment by realistically considering the status of the patient and with through the IC response and the molecular factors from the protein level comprehensive analysis. (author)

Outcomes From the First Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare Invitational Expert Forum.

Science.gov (United States)

Melnyk, Bernadette Mazurek; Gallagher-Ford, Lynn; Zellefrow, Cindy; Tucker, Sharon; Van Dromme, Laurel; Thomas, Bindu Koshy

2018-02-01

Even though multiple positive outcomes are the result of evidence-based care, including improvements in healthcare quality, safety, and costs, it is not consistently delivered by clinicians in healthcare systems throughout the world. In an attempt to accelerate the implementation of evidence-based practice (EBP) across the United States, an invitational Interprofessional National EBP Forum to determine major priorities for the advancement of EBP was held during the launch of the newly established Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at The Ohio State University College of Nursing. Interprofessional leaders from national organizations and federal agencies across the United States were invited to participate in the Forum. A pre-Forum survey was disseminated to participants to assess their perceptions of the state of EBP and actions necessary to speed the translation of research into real-world clinical settings. Findings from a pre-Forum survey (n = 47) indicated ongoing low implementation of EBP in U.S. healthcare settings. These findings were shared with leaders from 45 organizations and agencies who attended the Forum. Breakout groups on practice, education, implementation science, and policy discussed the findings and responded to a set of standardized questions. High-priority action tactics were identified, including the need for: (a) enhanced reimbursement for EBP, (b) more interprofessional education and skills building in EBP, and (c) leaders to prioritize EBP and fuel it with resources. The delivery of and reimbursement for evidence-based care must become a high national priority. Academic faculty across all healthcare disciplines need to teach EBP, healthcare systems must invest in EBP resources, and payers must attach reimbursement to care that is evidence-based. An action collaborative of the participating organizations has been formed to accelerate EBP across the United States to achieve the

Eestlanna püüab murda da Vinci koodi / Sash Uusjärv

Index Scriptorium Estoniae

Uusjärv, Sash

2010-01-01

Kadrioru Kunstimuuseumis eksponeeri 5.-12. veebruarini 2010. a. Leonardo da Vinci arvatavat autoportreed. Portree leiti 2008. aastal ühest Lõuna-Itaalia erakogust ja graafiline disainer Helen Kokk valmistas maali järgi arvutimudeli. Disainer Helen Kokka mõtteid tööprotsessitst

Survey of practices around pharmaceutical company funding for continuing professional development among medical oncologists and trainees in Australia.

Science.gov (United States)

Lee, Yeh Chen; Kroon, René; Koczwara, Bogda; Haines, Ian; Francis, Kay; Millward, Michael; Kefford, Richard; Olver, Ian; Mileshkin, Linda

2017-08-01

The completion of continuing professional development (CPD) is mandatory for medical oncologists and trainees (MO&T). Pharmaceutical companies may fund some CPD activities, but there is increasing debate about the potential for conflicts of interest (COI). To assess current practices around funding to attend CPD activities. An electronic survey was distributed to Australian MO&T. The survey asked questions about current practices, institutional policies and perceptions about attending CPD funded by pharmaceutical companies. The design looked at comparing responses between MO&T as well as their understanding of and training around institutional and ethical process. A total of 157 of 653 (24%) responses was received, the majority from MO (76%). Most CPD activities attended by MO&T were self-funded (53%), followed by funding from institutions (19%), pharmaceutical companies (16%) and salary award (16%). Most institutions allowed MO&T to receive CPD funding from professional organisations (104/157, 66%) or pharmaceutical companies (90/157, 57%). A minority of respondents (13/157, 8%) reported that the process to use pharmaceutical funds had been considered by an ethics committee. Although 103/157 (66%) had received pharmaceutical funding for CPD, most (109/157, 69%) reported never receiving training about potential COI. The lack of education was more noticeable among trainees (odds ratio (OR) 8.61, P = 0.02). MO&T acknowledged the potential bias towards a pharmaceutical product (P = 0.05) but believed there was adequate separation between themselves and pharmaceutical companies (P < 0.01). Majority of CPD attended by MO&T is self-funded. There is lack of clarity in institutional policies regarding external funding support for CPD activities. Formal education about potential COI is lacking. © 2017 Royal Australasian College of Physicians.

Attracting Future Radiation Oncologists: An Analysis of the National Resident Matching Program Data Trends From 2004 to 2015.

Science.gov (United States)

Ahmed, Awad A; Holliday, Emma B; Deville, Curtiland; Jagsi, Reshma; Haffty, Bruce G; Wilson, Lynn D

2015-12-01

A significant physician shortage has been projected to occur by 2025, and demand for oncologists is expected to outpace supply to an even greater degree. In response to this, many have called to increase the number of radiation oncology residency positions. The purpose of this study is to evaluate National Resident Matching Program (NRMP) data for the number of residency positions between 2004 and 2015 as well as the number and caliber of applicants for those positions and to compare radiation oncology to all residency specialties. NRMP data for all specialties participating in the match, including radiation oncology, were assessed over time examining the number of programs participating in the match, the number of positions offered, and the ratio of applicants to positions in the match from 2004 to 2015. From 2004 to 2015, the number of total programs participating in the match has increased by 26.7%, compared to the increase of 28.6% in the number of radiation oncology programs from during the same time period. The total number of positions offered in the match increased by 53.4%, whereas radiation oncology positions increased by 56.3%, during the same time period. The ratio of applicants (defined as those selecting a specialty as their first or only choice) to positions for all specialties has fluctuated over this time period and has gone from 1.21 to 1.15, whereas radiation oncology experienced a decrease from 1.45 to 1.14. NRMP data suggest that senior medical student applications to radiation oncology are decreasing compared to those of other specialties. If we hope to continue to attract the best and brightest to enter our field, we must continue to support early exposure to radiation oncology, positive educational experiences, and dedicated mentorship to interested medical students. Copyright © 2015 Elsevier Inc. All rights reserved.

Attracting Future Radiation Oncologists: An Analysis of the National Resident Matching Program Data Trends From 2004 to 2015

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Ahmed, Awad A., E-mail: Awad.ahmed@jhsmiami.org [Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States); Holliday, Emma B. [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Jagsi, Reshma [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Haffty, Bruce G. [Department of Radiation Oncology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Wilson, Lynn D. [Department of Therapeutic Radiology, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut (United States)

2015-12-01

Purpose: A significant physician shortage has been projected to occur by 2025, and demand for oncologists is expected to outpace supply to an even greater degree. In response to this, many have called to increase the number of radiation oncology residency positions. The purpose of this study is to evaluate National Resident Matching Program (NRMP) data for the number of residency positions between 2004 and 2015 as well as the number and caliber of applicants for those positions and to compare radiation oncology to all residency specialties. Methods: NRMP data for all specialties participating in the match, including radiation oncology, were assessed over time examining the number of programs participating in the match, the number of positions offered, and the ratio of applicants to positions in the match from 2004 to 2015. Results: From 2004 to 2015, the number of total programs participating in the match has increased by 26.7%, compared to the increase of 28.6% in the number of radiation oncology programs from during the same time period. The total number of positions offered in the match increased by 53.4%, whereas radiation oncology positions increased by 56.3%, during the same time period. The ratio of applicants (defined as those selecting a specialty as their first or only choice) to positions for all specialties has fluctuated over this time period and has gone from 1.21 to 1.15, whereas radiation oncology experienced a decrease from 1.45 to 1.14. Conclusions: NRMP data suggest that senior medical student applications to radiation oncology are decreasing compared to those of other specialties. If we hope to continue to attract the best and brightest to enter our field, we must continue to support early exposure to radiation oncology, positive educational experiences, and dedicated mentorship to interested medical students.

How Radiation Oncologists Evaluate and Incorporate Life Expectancy Estimates Into the Treatment of Palliative Cancer Patients: A Survey-Based Study

International Nuclear Information System (INIS)

Tseng, Yolanda D.; Krishnan, Monica S.; Sullivan, Adam J.; Jones, Joshua A.; Chow, Edward; Balboni, Tracy A.

2013-01-01

Purpose: We surveyed how radiation oncologists think about and incorporate a palliative cancer patient’s life expectancy (LE) into their treatment recommendations. Methods and Materials: A 41-item survey was e-mailed to 113 radiation oncology attending physicians and residents at radiation oncology centers within the Boston area. Physicians estimated how frequently they assessed the LE of their palliative cancer patients and rated the importance of 18 factors in formulating LE estimates. For 3 common palliative case scenarios, physicians estimated LE and reported whether they had an LE threshold below which they would modify their treatment recommendation. LE estimates were considered accurate when within the 95% confidence interval of median survival estimates from an established prognostic model. Results: Among 92 respondents (81%), the majority were male (62%), from an academic practice (75%), and an attending physician (70%). Physicians reported assessing LE in 91% of their evaluations and most frequently rated performance status (92%), overall metastatic burden (90%), presence of central nervous system metastases (75%), and primary cancer site (73%) as “very important” in assessing LE. Across the 3 cases, most (88%-97%) had LE thresholds that would alter treatment recommendations. Overall, physicians’ LE estimates were 22% accurate with 67% over the range predicted by the prognostic model. Conclusions: Physicians often incorporate LE estimates into palliative cancer care and identify important prognostic factors. Most have LE thresholds that guide their treatment recommendations. However, physicians overestimated patient survival times in most cases. Future studies focused on improving LE assessment are needed

How Radiation Oncologists Evaluate and Incorporate Life Expectancy Estimates Into the Treatment of Palliative Cancer Patients: A Survey-Based Study

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Tseng, Yolanda D., E-mail: ydtseng@partners.org [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Krishnan, Monica S. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Sullivan, Adam J. [Department of Biostatistics, Harvard University, Cambridge, Massachusetts (United States); Jones, Joshua A. [Harvard Palliative Medicine Fellowship Program, Boston, Massachusetts (United States); Chow, Edward [Department of Radiation Oncology, University of Toronto, Toronto (Canada); Balboni, Tracy A. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States)

2013-11-01

Purpose: We surveyed how radiation oncologists think about and incorporate a palliative cancer patient’s life expectancy (LE) into their treatment recommendations. Methods and Materials: A 41-item survey was e-mailed to 113 radiation oncology attending physicians and residents at radiation oncology centers within the Boston area. Physicians estimated how frequently they assessed the LE of their palliative cancer patients and rated the importance of 18 factors in formulating LE estimates. For 3 common palliative case scenarios, physicians estimated LE and reported whether they had an LE threshold below which they would modify their treatment recommendation. LE estimates were considered accurate when within the 95% confidence interval of median survival estimates from an established prognostic model. Results: Among 92 respondents (81%), the majority were male (62%), from an academic practice (75%), and an attending physician (70%). Physicians reported assessing LE in 91% of their evaluations and most frequently rated performance status (92%), overall metastatic burden (90%), presence of central nervous system metastases (75%), and primary cancer site (73%) as “very important” in assessing LE. Across the 3 cases, most (88%-97%) had LE thresholds that would alter treatment recommendations. Overall, physicians’ LE estimates were 22% accurate with 67% over the range predicted by the prognostic model. Conclusions: Physicians often incorporate LE estimates into palliative cancer care and identify important prognostic factors. Most have LE thresholds that guide their treatment recommendations. However, physicians overestimated patient survival times in most cases. Future studies focused on improving LE assessment are needed.

American Society for Radiation Oncology (ASTRO) 2012 Workforce Study: The Radiation Oncologists' and Residents' Perspectives

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Pohar, Surjeet, E-mail: spohar@iuhealth.org [Indiana University Health East, Indianapolis, Indiana (United States); Fung, Claire Y. [Commonwealth Newburyport Cancer Center, Newburyport, Massachusetts (United States); Hopkins, Shane [William R. Bliss Cancer Center, Ames, Iowa (United States); Miller, Robert [Mayo Clinic, Rochester, Minnesota (United States); Azawi, Samar [VA Veteran Hospital/University of California Irvine, Newport Beach, California (United States); Arnone, Anna; Patton, Caroline [ASTRO, Fairfax, Virginia (United States); Olsen, Christine [Massachusetts General Hospital, Boston, Massachusetts (United States)

2013-12-01

Purpose: The American Society for Radiation Oncology (ASTRO) conducted the 2012 Radiation Oncology Workforce Survey to obtain an up-to-date picture of the workforce, assess its needs and concerns, and identify quality and safety improvement opportunities. The results pertaining to radiation oncologists (ROs) and residents (RORs) are presented here. Methods: The ASTRO Workforce Subcommittee, in collaboration with allied radiation oncology professional societies, conducted a survey study in early 2012. An online survey questionnaire was sent to all segments of the radiation oncology workforce. Respondents who were actively working were included in the analysis. This manuscript describes the data for ROs and RORs. Results: A total of 3618 ROs and 568 RORs were surveyed. The response rate for both groups was 29%, with 1047 RO and 165 ROR responses. Among ROs, the 2 most common racial groups were white (80%) and Asian (15%), and the male-to-female ratio was 2.85 (74% male). The median age of ROs was 51. ROs averaged 253.4 new patient consults in a year and 22.9 on-treatment patients. More than 86% of ROs reported being satisfied or very satisfied overall with their career. Close to half of ROs reported having burnout feelings. There was a trend toward more frequent burnout feelings with increasing numbers of new patient consults. ROs' top concerns were related to documentation, reimbursement, and patients' health insurance coverage. Ninety-five percent of ROs felt confident when implementing new technology. Fifty-one percent of ROs thought that the supply of ROs was balanced with demand, and 33% perceived an oversupply. Conclusions: This study provides a current snapshot of the 2012 radiation oncology physician workforce. There was a predominance of whites and men. Job satisfaction level was high. However a substantial fraction of ROs reported burnout feelings. Perceptions about supply and demand balance were mixed. ROs top concerns reflect areas of attention

Runout distance and dynamic pressure of pyroclastic density currents: Evidence from 18 May 1980 blast surge of Mount St. Helens

Science.gov (United States)

Gardner, J. E.; Andrews, B. J.

2016-12-01

Pyroclastic density currents (flows and surges) are one of the most deadly hazards associated with volcanic eruptions. Understanding what controls how far such currents will travel, and how their dynamic pressure evolves, could help mitigate their hazards. The distance a ground hugging, pyroclastic density current travels is partly limited by when it reverses buoyancy and lifts off into the atmosphere. The 1980 blast surge of Mount St. Helens offers an example of a current seen to lift off. Before lofting, it had traveled up to 20 km and leveled more than 600 km3 of thick forest (the blowdown zone). The outer edge of the devastated area - where burned trees that were left standing (the singe zone) - is where the surge is thought to have lifted off. We recently examined deposits in the outer parts of the blowdown and in the singe zone at 32 sites. The important finding is that the laterally moving surge travelled into the singe zone, and hence the change in tree damage does not mark the run out distance of the ground hugging surge. Eyewitness accounts and impacts on trees and vehicles reveal that the surge consisted of a fast, dilute "overcurrent" and a slower "undercurrent", where most of the mass (and heat) was retained. Reasonable estimates for flow density and velocity show that dynamic pressure of the surge (i.e., its ability to topple trees) peaked near the base of the overcurrent. We propose that when the overcurrent began to lift off, the height of peak dynamic pressure rose above the trees and stopped toppling them. The slower undercurrent continued forward, burning trees but it lacked the dynamic pressure needed to topple them. Grain-size variations argue that it slowed from 30 m/s when it entered the singe zone to 3 m/s at the far end. Buoyancy reversal and liftoff are thus not preserved in the deposits where the surge lofted upwards.

[Volcanoes: A Compilation of Four Articles Appearing in Issues of "Instructor,""Science and Children," and "Science Teacher" Magazines in September 1980 and March 1981.

Science.gov (United States)

San Mateo County Office of Education, Redwood City, CA. SMERC Information Center.

This compilation of four journal articles (Instructor, September 1980; Science and Children, September 1980; and Science Teacher, September 1980 and March 1981) focuses on volcanoes, particularly Mount St. Helens in Oregon. The first article, "The Earth is Alive!" describes the eruptions of Mount St. Helens, provides basic information on…

Clinical management of gastric cancer: results of a multicentre survey

International Nuclear Information System (INIS)

Zhang, Xiaolong; Wen, Feng; Jiang, Yu; Xu, Feng; Feng, Hong; Bi, Feng; Li, Qiu; Li, Nanjing; Wei, Wen; Yao, Wenxiu; Xie, Ke; Hu, Jiankun; Shen, Lida; Ji, Weizheng; Lu, You

2011-01-01

The National Comprehensive Cancer Network clinical practice guidelines in oncology-gastric cancer guidelines have been widely used to provide appropriate recommendations for the treatment of patients with gastric cancer. The aim of this study was to examine the adherence of surgical oncologists, medical oncologists, and radiation oncologists' to the recommended guidelines. A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer. Analysis of 358 respondents (91%) showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines. These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines

Source mechanism of small long-period events at Mount St. Helens in July 2005 using template matching, phase-weighted stacking, and full-waveform inversion

Science.gov (United States)

Matoza, Robin S.; Chouet, Bernard A.; Dawson, Phillip B.; Shearer, Peter M.; Haney, Matthew M.; Waite, Gregory P.; Moran, Seth C.; Mikesell, T. Dylan

2015-01-01

Long-period (LP, 0.5-5 Hz) seismicity, observed at volcanoes worldwide, is a recognized signature of unrest and eruption. Cyclic LP “drumbeating” was the characteristic seismicity accompanying the sustained dome-building phase of the 2004–2008 eruption of Mount St. Helens (MSH), WA. However, together with the LP drumbeating was a near-continuous, randomly occurring series of tiny LP seismic events (LP “subevents”), which may hold important additional information on the mechanism of seismogenesis at restless volcanoes. We employ template matching, phase-weighted stacking, and full-waveform inversion to image the source mechanism of one multiplet of these LP subevents at MSH in July 2005. The signal-to-noise ratios of the individual events are too low to produce reliable waveform-inversion results, but the events are repetitive and can be stacked. We apply network-based template matching to 8 days of continuous velocity waveform data from 29 June to 7 July 2005 using a master event to detect 822 network triggers. We stack waveforms for 359 high-quality triggers at each station and component, using a combination of linear and phase-weighted stacking to produce clean stacks for use in waveform inversion. The derived source mechanism pointsto the volumetric oscillation (~10 m3) of a subhorizontal crack located at shallow depth (~30 m) in an area to the south of Crater Glacier in the southern portion of the breached MSH crater. A possible excitation mechanism is the sudden condensation of metastable steam from a shallow pressurized hydrothermal system as it encounters cool meteoric water in the outer parts of the edifice, perhaps supplied from snow melt.

Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

Science.gov (United States)

Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

2018-01-01

Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

36 CFR 264.11 - Use of symbol.

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Use of symbol. 264.11 Section... MANAGEMENT Mount St. Helens National Volcanic Monument Symbol § 264.11 Use of symbol. Except as provided in § 264.12, use of the Mount St. Helens National Volcanic Monument official symbol, including a facsimile...

76 FR 11985 - Acquisition Regulation: Department of Energy Acquisition Regulation, Government Property

Science.gov (United States)

2011-03-04

.... Comments by e-mail are encouraged. FOR FURTHER INFORMATION CONTACT: Helene Abbott at (202) 287-1593 or via e-mail: helene.abbott@hq.doe.gov . SUPPLEMENTARY INFORMATION: Background Section-by-Section Analysis... the Idaho National Lab and has been in use since the late 1990s. The PIDS system is used by both DOE...

Radiation dose to the patient and the radiologist while performing on chest computed tomography: a program of early diagnosis of lung cancer, biopsy and treatment simulation guided radiation oncologist breast cancer; Dosis de radiacion al paciente y al radiologo durante la realizacion de tomografia computarizada en torax: progrma de diagnostico precoz del cancer de pulmon, biopsia guiada y simulacion del tratamiento oncologo radioterapico del cancer de mama

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Pastor Sanchis, V.; Martinez Sanchez, J. M.; Palma Copete, J. D.; Crispin Contreras, V.; Casal Zamorano, E.; Dolores Alemany, V. de los; Gonzalez Perez, V.; Gimeno Olmo, J.; Guardino de la Flor, C.

2011-07-01

In this paper we determine the equivalent dose received by the operator and patient lung biopsies using thermoluminescence dosimeters, are established recommendations that this dose is as low as possible. It also reviews the acquisition protocols in both CT scans in early diagnosis program cited as the acquisition of CT for treatment planning dosimetric radiation oncologist in breast cancer.

Responding to family requests for nondisclosure: The impact of oncologists′ cultural background

Directory of Open Access Journals (Sweden)

Mahati Chittem

2015-01-01

Full Text Available Context: Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. Aims: To explore differences in the attitudes and practices of Western-born and nonWestern born oncologists in Australia when faced with a nondisclosure request. Settings and Design: Using a cross-sectional design, oncologists were interviewed over the telephone. Methods: Using the snowball method, 14 Australian (Western = 9, non-Western = 5 oncologists were recruited. Oncologists participated in a semi-structured interview exploring their experiences of, and response to, a request for nondisclosure, and their perceptions of how their cultural background influenced these attitudes and responses. Analysis: The interviews were transcribed and analyzed using interpretative phenomenological analysis. Results: Six main themes emerged from the study: (1 Barriers to truthful communication, (2 an ethical and moral dilemma, (3 high costs of nondisclosure, (4 cultural influences on interpretation and understanding of requests for nondisclosure, (5 emotional impact of bad news on patients, families and oncologists, and (6 truthful disclosure as a gentle balancing act. Conclusions: All oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. Some immigrant Australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. Irrespective of their cultural background, all oncologists acknowledged that breaking bad news had to be done in a gentle, gradual manner. The study suggests a need to develop a culturally sensitive cancer communication model.

A national survey of HDR source knowledge among practicing radiation oncologists and residents: Establishing a willingness-to-pay threshold for cobalt-60 usage.

Science.gov (United States)

Mailhot Vega, Raymond; Talcott, Wesley; Ishaq, Omar; Cohen, Patrice; Small, Christina J; Duckworth, Tamara; Sarria Bardales, Gustavo; Perez, Carmen A; Schiff, Peter B; Small, William; Harkenrider, Matthew M

Ir-192 is the predominant source for high-dose-rate (HDR) brachytherapy in United States markets. Co-60, with longer half-life and fewer source exchanges, has piloted abroad with comparable clinical dosimetry but increased shielding requirements. We sought to identify practitioner knowledge of Co-60 and establish acceptable willingness-to-pay (WTP) thresholds for additional shielding requirements for use in future cost-benefit analysis. A nationwide survey of U.S. radiation oncologists was conducted from June to July 2015, assessing knowledge of HDR sources, brachytherapy unit shielding, and factors that may influence source-selection decision-making. Self-identified decision makers in radiotherapy equipment purchase and acquisition were asked their WTP on shielding should a more cost-effective source become available. Four hundred forty surveys were completed and included. Forty-four percent were ABS members. Twenty percent of respondents identified Co-60 as an HDR source. Respondents who identified Co-60 were significantly more likely to be ABS members, have attended a national brachytherapy conference, and be involved in brachytherapy selection. Sixty-six percent of self-identified decision makers stated that their facility would switch to a more cost-effective source than Ir-192, if available. Cost and experience were the most common reasons provided for not switching. The most common WTP value selected by respondents was decision makers to establish WTP for shielding costs that source change to Co-60 may require. These results will be used to establish WTP threshold for future cost-benefit analysis. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Popmuusika / Helen Sildna

Index Scriptorium Estoniae

Sildna, Helen

2005-01-01

Uutest heliplaatidest Maxence Cyrin "Modern Rhapsodies", Mint Royale "See You In The Morning", Robbie Williams "Intesive", The Paddingtons "Fist Comes", Frank Sinatra With Tommy Dorsey "The Essential", Deep Purple "Rapture Of The Deep", Oleg Pissarenko "The Book's Burning"

The radiation oncologist`s perspective; Le point de vue du radiotherapeute

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Schlienger, M.; Touboul, E. [Hopital Tenon, 75 - Paris (France)

1998-03-01

During the last decade, stereotactic radiotherapy has widely improved in France. Thus one should study the present situation and its future trend. Fractionation of irradiation nowadays seems mandatory for most intracranial tumors except metastases and small regular arteriovenous malformations. Heterogeneity of lesion dose is related to the geometry and the physics of convergent fixed or mobile beams. It can be improved and the healthy tissue irradiation can be diminished using the multi-isocentric planning for complex lesion or with micro multi leaf collimators. For neurinomas of the acoustic nerve, fractionated stereotactic radiotherapy yields few of the complications published after single dose stereotactic radiotherapy. The same can be said for meningiomas although some series reported very few complications after single dose stereotactic radiotherapy. Solitary metastases without systemic evolution, not situated on the mid-line, are favorable candidates For palliative single dose stereotactic radiotherapy. The conjunction with total brain irradiation seems to be useful. Small arteriovenous malformations will be treated with single dose stereotactic radiotherapy, whereas voluminous and/or geometrically complex nidus could benefit from protons or photon beams modulated by micro multi leaf collimators and a few fractions. Single dose stereotactic radiotherapy and fractionated stereotactic radiotherapy will be used as boost in various situations such as massif facial and in all sorts of tumors in the body specially when lesions are close to critical organs. (author)

Agreement for depression diagnosis between DSM-IV-TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer

Directory of Open Access Journals (Sweden)

Rhondali W

2015-07-01

Full Text Available Wadih Rhondali,1 Gilles Freyer,2 Virginie Adam,3 Marilène Filbet,4 Martine Derzelle,5 Gaelle Abgrall-Barbry,6 Sophie Bourcelot,7 Jean-Louis Machavoine,8 Muriel Chomat-Neyraud,9 Olivier Gisserot,10 Rémi Largillier,11 Annick Le Rol,12 Frank Priou,13 Pierre Saltel,14 Claire Falandry15 1Clinique Mon Repos, Clinea, Marseille, France; 2Medical Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France; 3Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-lès-Nancy, France; 4Palliative Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France; 5Institut Jean Godinot, Reims, France; 6Tenon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 7Centre Léon Bérard, Lyon, France; 8Centre François Baclesse, Caen, France; 9Centre Hospitalier de la région d’Annecy, Pringy, France; 10Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France; 11Centre Azuréen de Cancérologie, Mougins, France; 12Medical Oncology, Hôpital Perpétuel Secours, Levallois-Perret, France; 13Medical Oncology, Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France; 14Supportive Care Department, Centre Léon Bérard, Lyon, France; 15Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France Background: Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA, and psychiatric clinical interview (PCI in elderly patients with advanced ovarian cancer (AOC.Methods: This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3, designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS, the Hospital

Topographic controls on pyroclastic density current dynamics: Insight from 18 May 1980 deposits at Mount St. Helens, Washington (USA)

Science.gov (United States)

Brand, Brittany D.; Bendaña, Sylvana; Self, Stephen; Pollock, Nicholas

2016-07-01

Our ability to interpret the deposits of pyroclastic density currents (PDCs) is critical for understanding the transport and depositional processes that control PDC dynamics. This paper focuses on the influence of slope on flow dynamics and criticality as recorded in PDC deposits from the 18 May 1980 eruption of Mt. St. Helens (USA). PDC deposits are found along the steep flanks (10°-30°) and across the pumice plain ( 5°) up to 8 km north of the volcano. Granulometry, componentry and descriptions of depositional characteristics (e.g., bedform morphology) are recorded with distance from source. The pumice plain deposits are primarily thick (3-12 m), massive and poorly-sorted, and represent deposition from a series of concentrated PDCs. By contrast, the steep flank deposits are stratified to cross-stratified, suggesting deposition from PDCs where turbulence strongly influenced transport and depositional processes. We propose that acceleration of the concentrated PDCs along the steep flanks resulted in thinning of the concentrated, basal region of the current(s). Enhanced entrainment of ambient air, and autofluidization from upward fluxes of air from substrate interstices and plunging breakers across rugged, irregular topography further inflated the currents to the point that the overriding turbulent region strongly influenced transport and depositional mechanisms. Acceleration in combination with partial confinement in slot canyons and high surface roughness would also increase basal shear stress, further promoting shear and traction transport in the basal region of the current. Conditions along the steep flank resulted in supercritical flow, as recorded by regressive bedforms, which gradually transitioned to subcritical flow downstream as the concentrated basal region thickness increased as a function of decreasing slope and flow energy. We also find that (1) PDCs were erosive into the underlying granular substrate along high slopes (> 25°) where currents were

A closer look at the pyroclastic density current deposits of the May 18, 1980 eruption of Mt St Helens

Science.gov (United States)

Mackaman-Lofland, C. A.; Brand, B. D.; Dufek, J.

2010-12-01

Pyroclastic Density Currents (PDCs) are the most dangerous hazard associated with explosive volcanic eruptions. Due to the danger associated with observing these ground-hugging currents of searing hot gas, ash, and rock in real time, their processes are poorly understood. In order to understand flow dynamics, including what controls how far PDCs travel and how they interact with topography, it is necessary to study their deposits. The May 18th, 1980 eruption of Mt. St. Helens produced multiple PDCs, burying the area north of the volcano under 10s of meters of PDC deposits. Because the eruption is one of the best observed on record, individual flow units can be correlated to changes in eruptive intensity throughout the day (e.g., Criswell, 1987). Deep drainage erosion over the past 30 years has exposed the three-dimensional structure of the PDC deposits, making this intensive study possible. Up to six flow units have been identified along the large western drainage of the pumice plain. Each flow unit has intricate vertical and lateral facies changes and complex cross-cutting relationships away from source. The most proximal PDC deposits associated with the afternoon flows on May 18 are exposed 4 km from source in tributaries of the large drainage on the western side of the pumice plain. Hummocks from the debris avalanche are also exposed above and within these proximal drainages. It is apparent that the PDCs were often erosional, entraining large blocks from the hummocks and depositing them in close proximity downstream. The currents were also depositional, as thick sequences of PDC deposits are found in areas between hummocks, which thin to veneers above them. This indicates that the currents were interacting with complex topography early in their propagation, and is reflected by spatially variable bed conditions including rapid changes in bedding and granulometry characteristics within individual flow units. For example, within 20 lateral meters of a given flow

N-P Co-Limitation of Primary Production and Response of Arthropods to N and P in Early Primary Succession on Mount St. Helens Volcano

Science.gov (United States)

Bishop, John G.; O'Hara, Niamh B.; Titus, Jonathan H.; Apple, Jennifer L.; Gill, Richard A.; Wynn, Louise

2010-01-01

Background The effect of low nutrient availability on plant-consumer interactions during early succession is poorly understood. The low productivity and complexity of primary successional communities are expected to limit diversity and abundance of arthropods, but few studies have examined arthropod responses to enhanced nutrient supply in this context. We investigated the effects of nitrogen (N) and phosphorus (P) addition on plant productivity and arthropod abundance on 24-yr-old soils at Mount St. Helens volcano. Methodology/Principal Findings We measured the relative abundance of eight arthropod orders and five families in plots that received N, P, or no nutrients for 3–5 years. We also measured plant % cover, leaf %N, and plant diversity. Vegetation responded rapidly to N addition but showed a lagged response to P that, combined with evidence of increased N fixation, suggested P-limitation to N availability. After 3 yrs of fertilization, orthopterans (primarily Anabrus simplex (Tettigoniidae) and Melanoplus spp (Acrididae)) showed a striking attraction to P addition plots, while no other taxa responded to fertilization. After 5 yrs of fertilization, orthopteran density in the same plots increased 80%–130% with P addition and 40% with N. Using structural equation modeling, we show that in year 3 orthopteran abundance was associated with a P-mediated increase in plant cover (or correlated increases in resource quality), whereas in year 5 orthopteran density was not related to cover, diversity or plant %N, but rather to unmeasured effects of P, such as its influence on other aspects of resource quality. Conclusions/Significance The marked surprising response to P by orthopterans, combined with a previous observation of P-limitation in lepidopteran herbivores at these sites, suggests that P-mediated effects of food quantity or quality are critical to insect herbivores in this N-P co-limited primary successional system. Our results also support a previous

Tratado Sobre os gigantes, de Fílon de Alexandria: apresentação, tradução, notas

Directory of Open Access Journals (Sweden)

César Motta Rios

2008-03-01

Full Text Available A importância da obra de Fílon de Alexandria ainda hoje é múltipla e real inclusive para o judaísmo. Conforme observado por David Runia (RUNIA, 1990, p. 185-186, seu estudo é válido para qualquer um que se interesse por literatura judaico-­helenística, judaísmo do segundo templo, Novo Testamento, patrística e gnosticismo, cultura helenística e filosofia grega.

Tracking the workforce: the American Society of Clinical Oncology workforce information system.

Science.gov (United States)

Kirkwood, M Kelsey; Kosty, Michael P; Bajorin, Dean F; Bruinooge, Suanna S; Goldstein, Michael A

2013-01-01

In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. THE WIS REPORT IS COMPOSED OF THREE SECTIONS: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages.

Tracking the Workforce: The American Society of Clinical Oncology Workforce Information System

Science.gov (United States)

Kirkwood, M. Kelsey; Kosty, Michael P.; Bajorin, Dean F.; Bruinooge, Suanna S.; Goldstein, Michael A.

2013-01-01

Purpose: In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. Methods: The WIS report is composed of three sections: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. Results: The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Conclusion: Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages. PMID:23633965

100th International Women’s Day Celebrated at CERN

CERN Multimedia

Katarina Anthony

2011-01-01

In celebration of the 100th year of International Women’s Day on 8 March, a special colloquium looking at high energy physics from a gender studies perspective was held at CERN.   Addressing a packed conference room, Helene Goetschel, a visiting gender studies researcher from Uppsala University, gave a presentation on a subject unfamiliar to most physicists: sociology. And more specifically, on the findings of gender researchers examining the field of high energy physics. “It was heartening to see so many CERN physicists interested in hearing how sociologists and historians see their community,” said Helene. “Examining our personal issues with gender is difficult, and I applaud anyone who takes an interest in the subject.” Helene Goetschel began her academic career in high-energy physics, but encountered a 'glass ceiling' in her work. In 1990, she decided to change the focus of her studies to the history of science – specifically looking ...

Hot pressing and lithification of gouge during the Mount St. Helens 2004-2008 eruption: insights from high temperature deformation experiments

Science.gov (United States)

Ryan, Amy G.; Russell, James K.; Heap, Michael J.

2017-04-01

We present results from an experimental program designed to investigate the timescales, conditions and mechanisms responsible for the densification and lithification of volcanic gouge at Mount St. Helens (MSH). From 2004-2008, MSH produced a series of lava domes/spines that were mantled by thick layers of gouge resulting from fracturing and cataclasis at the conduit-wall rock interface. The gouge comprises fine crystal-rich rock powder containing little to no glass. The erupted gouge carapace is texturally diverse, and varies from loose granular material to moderately indurated coherent rock to fine-grained cataclasite within tens of centimeters. The spatial association of these materials suggests that the originally unconsolidated conduit-fault gouge is densified and lithified during ascent to the surface. At present the conditions, timescales and mechanisms for lithification of the glass-poor materials are unknown. Here, we present results from a series of high-temperature (T) uniaxial deformation experiments performed on natural gouge collected from MSH (spine 5). The experiments are intended to (1) establish the feasibility of experimentally densifying/lithifying natural gouge materials at laboratory conditions approximating those within the MSH conduit, and to (2) constrain the effects of T, load and time on the extents, rates and mechanisms of densification. Our experimental conditions include T up to 800°C (Tmelting), axial differential stresses up to 25 MPa and experimental times up to 90 hours. Experimental results will be compared to the physical properties (density, porosity, permeability, compressive strength and particle size distribution) of variably densified gouge samples from spines 4, 5 and 7 at MSH, tying the results from the lab to the natural system. Initial results show an increase in the amount and rate of densification with increasing experimental T, with an increase in sample shortening (axial strain) between experiments completed at 650

Field-trip guide for exploring pyroclastic density current deposits from the May 18, 1980, eruption of Mount St. Helens, Washington

Science.gov (United States)

Brand, Brittany D.; Pollock, Nicholas; Sarocchi, Damiano; Dufek, Josef; Clynne, Michael A.

2017-07-05

Pyroclastic density currents (PDCs) are one of the most dangerous phenomena associated with explosive volcanism. To help constrain damage potential, a combination of field studies, laboratory experiments, and numerical modeling are used to establish conditions that influence PDC dynamics and depositional processes, including runout distance. The objective of this field trip is to explore field relations that may constrain PDCs at the time of emplacement.The PDC deposits from the May 18, 1980, eruption of Mount St. Helens are well exposed along the steep flanks (10–30° slopes) and across the pumice plain (5–12° slopes) as far as 8 km north of the volcano. The pumice plain deposits represent deposition from a series of concentrated PDCs and are primarily thick (3–12 m), massive, and poorly sorted. In contrast, the steep east-flank deposits are stratified to cross-stratified, suggesting deposition from PDCs where turbulence strongly influenced transport and depositional processes.The PDCs that descended the west flank were largely nondepositional; they maintained a higher flow energy and carrying capacity than PDCs funneled through the main breach, as evidenced by the higher concentration of large blocks in their deposits. The PDC from the west flank collided with PDCs funneled through the breach at various points along the pumice plain. Evidence for flow collision will be explored and debated throughout the field trip.Evidence for substrate erosion and entrainment is found (1) along the steep eastern flank of the volcano, which has a higher degree of rough, irregular topography relative to the west flanks where PDCs were likely nonerosive, (2) where PDCs encountered debris-avalanche hummocks across the pumice plain, and (3) where PDCs eroded and entrained material deposited by PDCs produced during earlier phases of the eruption. Two features interpreted as large-scale (tens of meters wide) levees and a large (~200 m wide) channel scour-and-fill feature

Participation of Asian-American women in cancer treatment research: a pilot study.

Science.gov (United States)

Nguyen, Tung T; Somkin, Carol P; Ma, Yifei; Fung, Lei-Chun; Nguyen, Thoa

2005-01-01

Few Asian-American women participate in cancer treatment trials. In a pilot study to assess barriers to participation, we mailed surveys to 132 oncologists and interviewed 19 Asian-American women with cancer from Northern California. Forty-four oncologists responded. They reported as barriers language problems, lack of culturally relevant cancer information, and complex protocols. Most stated that they informed Asian-American women about treatment trials. Only four women interviewed knew about trials. Other patient-identified barriers were fear of side effects, language problems, competing needs, and fear of experimentation. Family decision making was a barrier for both oncologists and patients. Compared to non-Asian oncologists, more Asian oncologists have referred Asian-American women to industry trials and identified barriers similar to patients' reports. Our findings indicate that Asian-American women need to be informed about cancer treatment trials, linguistic barriers should be addressed, and future research should evaluate cultural barriers such as family decision making.

Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set.

Science.gov (United States)

Vu, Charles C; Lanni, Thomas B; Robertson, John M

2016-04-01

The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology. The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state. There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (Preimbursement. The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other specialists. Male sex and rural practice location are independent predictors of higher total Medicare reimbursements. Copyright © 2016 Elsevier Inc. All rights reserved.

Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set

International Nuclear Information System (INIS)

Vu, Charles C.; Lanni, Thomas B.; Robertson, John M.

2016-01-01

Purpose: The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology. Methods and Materials: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state. Results: There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (P<.001). On multivariate analysis, technical services billing (P<.001), male sex (P<.001), and rural location (P=.007) were predictive of higher Medicare reimbursement. Conclusions: The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other

Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set

Energy Technology Data Exchange (ETDEWEB)

Vu, Charles C.; Lanni, Thomas B.; Robertson, John M., E-mail: JRobertson@beaumont.edu

2016-04-01

Purpose: The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology. Methods and Materials: The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state. Results: There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (P<.001). On multivariate analysis, technical services billing (P<.001), male sex (P<.001), and rural location (P=.007) were predictive of higher Medicare reimbursement. Conclusions: The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other

A study into the review and verification of breast images treated with isocentric technique

International Nuclear Information System (INIS)

Mitchell, Fiona

2007-01-01

In radiation therapy practice, portal imaging is a common occurrence. Radiation Oncologists want to be able to view the actual treatment port and compare it to the simulated view for quality assurance. Historically, this has been the domain of oncologists only but with the changes in imaging technology, this area of practice is now more commonly shared with the radiation therapists. Purpose: The primary aim of this study was to compare the Radiation Therapists' result versus the Radiation Oncologists' practice of review and verification of electronic portal imaging in the treatment of breast cancer. A secondary result was enhancement of electronic portal imaging use. Methods: The study was divided into two parts. Part 1 reviewed imaging of tangential breast treatment and part 2 reviewed mono-isocentric four-field breast technique. The review and verification of the images were conducted by the Radiation Therapists and Radiation Oncologists and their subsequent results were compared. Results: Overall the Radiation Oncologist agreed with 96.9% of the images approved by the Radiation Therapists. This makes for a rejection rate of 3.1%. In general, Radiation Therapists adhered to the guidelines more closely than the Radiation Oncologist hence the rejection rate of Radiation Therapists was greater than the Radiation Oncologist by 7.0%. Conclusions: The practice of electronic portal imaging review and verification in the treatment of breast cancer can be streamlined and achieved more efficiently. The Radiation Therapists consistently demonstrated their ability to review and verify the portal images, as equivalent to the Radiation Oncologist. Given the high standard of accuracy demonstrated the process of portal image review should be transferred to the Radiation Therapist. This transfer leads to reduction in duplicity of task, an increase in the use of technology, an improvement in efficiencies, and an increase in the quality of care, which will potentially lead to more

Practices in management of cancer treatment-related cardiovascular toxicity: A cardio-oncology survey.

Science.gov (United States)

Jovenaux, Ludovic; Cautela, Jennifer; Resseguier, Noemie; Pibarot, Michele; Taouqi, Myriam; Orabona, Morgane; Pinto, Johan; Peyrol, Michael; Barraud, Jeremie; Laine, Marc; Bonello, Laurent; Paganelli, Franck; Barlesi, Fabrice; Thuny, Franck

2017-08-15

Cardiovascular toxicity has become a challenging issue during cancer therapy. Nonetheless, there is a lack of consensual guidelines for their management. We aimed to determine the current practices of oncologists regarding cardiovascular toxicity related to anthracyclines, trastuzumab and angiogenic inhibitors and to gather their opinions on the development of cardio-oncology programs. A cross-sectional declarative study was submitted to French oncologists in the form of an individual, structured questionnaire. A total of 303 oncologists responded to the survey. Ninety-nine percent of oncologists prescribed cardiotoxic therapies, including anthracyclines (83%), trastuzumab (51%) and other angiogenic inhibitors (64%). The method adopted for managing cardiovascular toxicity was based on guidelines from expert oncology societies for only 35% of oncologists. None was aware of recommendations from expert cardiology societies. Prescription of pre-, peri- and post-therapy cardiovascular assessment was inconsistent and significantly less frequent for all classes of angiogenic inhibitors than for anthracyclines and trastuzumab (Poncology programs development. Practices of oncologists are disparate in the field of cardiovascular toxicity. This finding underlines the complexity of managing many different situations and the need for distribution of formal guidelines from oncology and cardiology expert societies. The development of personalized cardio-oncology programs seems essential. Copyright © 2017 Elsevier B.V. All rights reserved.

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

Science.gov (United States)

Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee

2017-01-01

Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality. PMID:26978124

Faculty of Radiation Oncology 2014 Workforce Census: a comparison of New Zealand and Australian responses.

Science.gov (United States)

James, Melissa; Munro, Philip M; Leung, John

2015-04-17

This paper outlines the key results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2014 workforce census, and compares the results of New Zealand and Australian responses in order to identify similarities and differences in workforce characteristics. The workforce census was conducted online in mid-2014. The census was distributed to all radiation oncologists (Fellows, life members, educational affiliates, retired) and radiation oncology trainees on the RANZCR membership database. Six weekly reminders were sent to non-respondents and all responses were aggregated for analysis. This paper addresses only consultant radiation oncologist responses. The combined response rate for New Zealand radiation oncologists was 85.7% (compared with 76% from Australian respondents). The census found that the demographic characteristics of New Zealand and Australian radiation oncologists are similar. Points of difference include (i) the role of educational affiliates in New Zealand, (ii) New Zealand radiation oncologists reporting higher hours spent at work, (iii) New Zealand radiation oncologists spending a higher proportion of time on clinical duties, (iv) A lower proportion of New Zealand radiation oncologists with higher degrees, and (v) private/ public workplace mix. A comparison by country would suggest that there are many similarities, but also some important differences that may affect workforce issues in New Zealand. Separate datasets are useful for RANZCR to better inform members, governments and other key stakeholders in each country. Separate datasets also provide a basis for comparison with future surveys to facilitate the monitoring of trends.

Põlisrahvaste deklaratsioon / Helen Arusoo

Index Scriptorium Estoniae

Arusoo, Helen, 1972-

2010-01-01

Urmas Sisask kuulutas Tuhala Nõiakaevu kaitseks välja Tuhala ja Nabala karstialadel rahvusvahelise tähtsusega looduskaitsealaks toetudes internetis kogutud 60 000 toetusallkirjale ja 2007. aastal Eesti poolt allkirjastatud ÜRO põlisrahvaste õiguste deklaratsioonile web-static.vm.ee/static/failid/298/Polisrahvaste_deklaratsioon_EST.pdf

Betoonist videograafika / Helen Kivisoo

Index Scriptorium Estoniae

Kivisoo, Helen

2001-01-01

12. augustini Helsingis MUU galeriis Jasper Zoova videoinstallatsioon "Hebel - Betoonehitus uuest aspektist" ja Tuukka Kaila (Soome) fotod "Heissulivei - Vaadake kui ilus - Check out me and my country".

BridgeUP: STEM. Creating Opportunities for Women through Tiered Mentorship

Science.gov (United States)

Secunda, Amy; Cornelis, Juliette; Ferreira, Denelis; Gomez, Anay; Khan, Ariba; Li, Anna; Soo, Audrey; Mac Low, Mordecai

2018-01-01

BridgeUP: STEM is an ambitious, and exciting initiative responding to the extensive gender and opportunity gaps that exist in the STEM pipeline for women, girls, and under-resourced youth. BridgeUP: STEM has developed a distinct identity in the landscape of computer science education by embedding programming in the context of scientific research. One of the ways in which this is accomplished is through a tiered mentorship program. Five Helen Fellows are chosen from a pool of female, postbaccalaureate applicants to be mentored by researchers at the American Museum of Natural History in a computational research project. The Helen Fellows then act as mentors to six high school women (Brown Scholars), guiding them through a computational project aligned with their own research. This year, three of the Helen Fellows, and by extension, eighteen Brown Scholars, are performing computational astrophysics research. This poster presents one example of a tiered mentorship working on modeling the migration of stellar mass black holes (BH) in active galactic nucleus (AGN) disks. Making an analogy from the well-studied migration and formation of planets in protoplanetary disks to the newer field of migration and formation of binary BH in AGN disks, the Helen Fellow is working with her mentors to make the necessary adaptations of an N-body code incorporating migration torques from the protoplanetary disk case to the AGN disk case to model how binary BH form. This is in order to better understand and make predictions for gravitational wave observations from the Laser Interferometer Gravitational-Wave Observatory (LIGO). The Brown Scholars then implement the Helen Fellow’s code for a variety of different distributions of initial stellar mass BH populations that they generate using python, and produce visualizations of the output to be used in a published paper. Over the course of the project, students will develop a basic understanding of the physics related to their project and

Radiosurgery scope of practice in Canada: A report of the Canadian association of radiation oncology (CARO) radiosurgery advisory committee

International Nuclear Information System (INIS)

Roberge, David; Menard, Cynthia; Bauman, Glenn; Chan, Alex; Mulroy, Liam; Sahgal, Arjun; Malone, Shawn; McKenzie, Michael; Schroeder, Garry; Fortin, Marie-Andree; Ebacher, Annie; Milosevic, Michael

2010-01-01

Radiosurgery has a long history in Canada. Since the treatment of the first patient at the McGill University Health Center in 1985, radiosurgery programs have been developed from coast to coast. These have included multidisciplinary teams of radiation oncologists, neurosurgeons, medical physicists, radiation technologists and other health professionals. In 2008, the CARO Board of Directors requested that a working group be formed to define the role of the radiation oncologist in the practice of radiosurgery. Taking into account evolving technology, changing clinical practice and current scope of practice literature, the working group made recommendations as to the role of the radiation oncologists. These recommendations were endorsed by the Canadian Association of Radiation Oncology board of directors in September 2009 and are present herein. It is recognized that patients benefit from a team approach to their care but it is recommended that qualified radiation oncologists be involved in radiosurgery delivery from patient consultation to follow-up. In addition, radiation oncologists should continue to be involved in the administrative aspects of radiosurgery programs, from equipment selection to ongoing quality assurance/quality improvement.

"What concerns me is..." Expression of emotion by advanced cancer patients during outpatient visits.

Science.gov (United States)

Anderson, Wendy G; Alexander, Stewart C; Rodriguez, Keri L; Jeffreys, Amy S; Olsen, Maren K; Pollak, Kathryn I; Tulsky, James A; Arnold, Robert M

2008-07-01

Cancer patients have high levels of distress, yet oncologists often do not recognize patients' concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists. As part of the Studying Communication in Oncologist-Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content. Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: "concern," "scared," "worried," "depressed," and "nervous." Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time. Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.

A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam [Automated Scheduling, Optimisation and Planning Research Group, School of Computer Science, University of Nottingham, Nottingham NG8 1BB (United Kingdom); Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB (United Kingdom)

2011-12-15

Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

A self-adaptive case-based reasoning system for dose planning in prostate cancer radiotherapy

International Nuclear Information System (INIS)

Mishra, Nishikant; Petrovic, Sanja; Sundar, Santhanam

2011-01-01

Purpose: Prostate cancer is the most common cancer in the male population. Radiotherapy is often used in the treatment for prostate cancer. In radiotherapy treatment, the oncologist makes a trade-off between the risk and benefit of the radiation, i.e., the task is to deliver a high dose to the prostate cancer cells and minimize side effects of the treatment. The aim of our research is to develop a software system that will assist the oncologist in planning new treatments. Methods: A nonlinear case-based reasoning system is developed to capture the expertise and experience of oncologists in treating previous patients. Importance (weights) of different clinical parameters in the dose planning is determined by the oncologist based on their past experience, and is highly subjective. The weights are usually fixed in the system. In this research, the weights are updated automatically each time after generating a treatment plan for a new patient using a group based simulated annealing approach. Results: The developed approach is analyzed on the real data set collected from the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. Extensive experiments show that the dose plan suggested by the proposed method is coherent with the dose plan prescribed by an experienced oncologist or even better. Conclusions: The developed case-based reasoning system enables the use of knowledge and experience gained by the oncologist in treating new patients. This system may play a vital role to assist the oncologist in making a better decision in less computational time; it utilizes the success rate of the previously treated patients and it can also be used in teaching and training processes.

Current status of medical oncology in Japan--reality gleaned from a questionnaire sent to designated cancer care hospitals.

Science.gov (United States)

Takiguchi, Yuichi; Sekine, Ikuo; Iwasawa, Shunichiro; Kurimoto, Ryota; Sakaida, Emiko; Tamura, Kenji

2014-07-01

Medical oncology in Japan has a relatively short history, with specialist certification starting in 2006, resulting in 867 certified medical oncologists as of 2014. Although the national government has appointed 397 Designated Cancer Care Hospitals, little is known about the actual situations of medical oncology services at these institutions. Questionnaires regarding the presence of a medical oncology department, the number of physicians in the department, the presence of certified medical oncologists and the degree of the medical oncologists' responsibilities for drug therapies in adults with solid cancers were sent to all 397 institutions between 21 January and 1 May 2013. The response rate was 68.0%. Among the responses, 39.4% of the institutions had medical oncology departments with a median of three physicians. Most of the medical oncology departments were primarily responsible, as evaluated according to patient number, for the treatment of limited disease categories. The medical oncologists were significantly more responsible for molecular-targeted therapy than for chemotherapy in head and neck cancer or for cytokine therapy in renal cell carcinoma. The wide variety of adverse events associated with molecular-targeted therapy might have enhanced the roles of medical oncologists. As the proportion of hospitals with a medical oncology department increased according to the number of certified medical oncologists working at the institution, cultivating medical oncologists seems to be an urgent task for advancing medical oncology in Japan. The present study provides fundamental data for the future development of medical oncology in Japan. The present study is to uncover the current situation of medical oncology in Japan. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Stereotactic Radiosurgery and Stereotactic Body Radiotherapy (SBRT)

Science.gov (United States)

... The radiation oncologist and, in some cases, a neurosurgeon lead the treatment team and oversee the treatment; ... In the case of the Gamma Knife, the neurosurgeon and/or radiation oncologist may help position the ...

Dramatically Polarized Opinion on the Role of Brachytherapy Boost in Management of High-risk Prostate Cancer: A Survey of North American Genitourinary Expert Radiation Oncologists.

Science.gov (United States)

McClelland, Shearwood; Sandler, Kiri A; Degnin, Catherine; Chen, Yiyi; Mitin, Timur

2018-06-01

Three randomized clinical trials have established brachytherapy (BT) boost in combination with external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT) as superior to definitive EBRT and ADT alone in terms of biochemical control (but not overall survival) at the expense of increased toxicity in men with high-risk (HR) prostate cancer (PCa). The current view regarding these 2 treatment algorithms among North American genitourinary (GU) experts is not known. A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to opinions regarding BT as monotherapy for low-risk PCa and BT boost for HR PCa. Responders were asked to self-identify as BT experts versus non-experts. Treatment recommendations were correlated with practice patterns using the Fisher exact test. Forty-two radiation oncologists completed the survey, of whom 23 (55%) recommend EBRT and ADT alone and 19 (45%) recommend addition of BT boost. Twenty-five participants (60%) identified themselves as BT experts. Nearly 90% of those recommending BT boost were BT experts versus approximately 10% of non-BT experts (P < .001). Responders who recommended BT monotherapy as first-choice treatment for low-risk PCa were more likely to recommend BT boost for HR PCa (P < .0001). There is a dramatic polarization in opinions regarding incorporation of BT boost into EBRT + ADT therapy for patients with HR PCa among North American GU radiation oncology experts, who serve on decision-making committees and influence the national treatment guidelines and future clinical trials. Those who identify themselves as BT experts are significantly more likely to recommend BT boost. These findings are likely to influence the national guidelines and implementation of BT boost in current and future North American PCa clinical studies. Copyright © 2018 Elsevier Inc. All rights reserved.

Shaping your career to maximize personal satisfaction in the practice of oncology.

Science.gov (United States)

Shanafelt, Tait; Chung, Harold; White, Heather; Lyckholm, Laurie Jean

2006-08-20

The practice of oncology can be a source of both great satisfaction and great stress. Although many oncologists experience burnout, depression, and dissatisfaction with work, others experience tremendous career satisfaction and achieve a high overall quality of life. Identifying professional goals, optimizing career fit, identifying and managing stressors specific to practice type, and achieving the optimal personal work-life balance can increase the likelihood of individual oncologists' achieving personal and professional satisfaction. In this article, we will explore how oncologists can accomplish these tasks and will examine several pervasive professional myths that often distort perspective. The article concludes in a conversation with four oncologists regarding what they find most meaningful about their work, how they manage career-specific stressors, and how they achieve balance between their personal and professional lives.

Faculty of Radiation Oncology 2014 workforce census.

Science.gov (United States)

Leung, John; Munro, Philip L; James, Melissa

2015-12-01

This paper reports the key findings of the Faculty of Radiation Oncology 2014 workforce census and compares the results with earlier surveys. The census was conducted in mid-2014 with distribution to all radiation oncologists, educational affiliates and trainees listed on the college database. There were six email reminders and responses were anonymous. The overall response rate was 76.1%. The age range of fellows was 32-96 (mean = 49 years, median = 47 years). The majority of the radiation oncologists were male (n = 263, 63%). The minority of radiation oncologists were of Asian descent (n = 43, 13.4%). Radiation oncologists graduated from medical school on average 23 years ago (median = 22 years). A minority of fellows (n = 66, 20%) held another postgraduate qualification. Most radiation oncologists worked, on average, at two practices (median = 2, range 1-7). Practising radiation oncologists worked predominantly in the public sector (n = 131, 49%), but many worked in both the public and private sectors (n = 94, 37%), and a minority worked in the private sector only (n = 38, 14%). The largest proportion of the workforce was from New South Wales accounting for 29% of radiation oncologists. Radiation oncologists worked an average of 43 h/week (median = 43 h, range 6-80). Radiation oncologists who worked in the private sector worked less hours than their public sector or public/private sector colleagues. (38.3 vs. 42.9 vs. 44.3 h, P = 0.042). Victorians worked the fewest average hours per week at 38 h and West Australians the most at 46 h/week. Radiation oncologists averaged 48 min for each new case, 17 min per follow up and 11 min for a treatment review. Radiation oncologists averaged 246 new patients per year (median = 250, range = 20-600) with men (average = 268), Western Australians (average = 354) and those in private practice seeing more (average = 275). Most radiation

Using program impact pathways to understand and improve program delivery, utilization, and potential for impact of Helen Keller International's homestead food production program in Cambodia.

Science.gov (United States)

Olney, Deanna K; Vicheka, Sao; Kro, Meng; Chakriya, Chhom; Kroeun, Hou; Hoing, Ly Sok; Talukder, Aminzzaman; Quinn, Victoria; Iannotti, Lora; Becker, Elisabeth; Roopnaraine, Terry

2013-06-01

Evidence of the impact of homestead food production programs on nutrition outcomes such as anemia and growth is scant. In the absence of information on program impact pathways, it is difficult to understand why these programs, which have been successful in increasing intake of micronutrient-rich foods, have had such limited documented impact on nutrition outcomes. To conduct a process evaluation of Helen Keller International's (HKI's) homestead food production program in Cambodia to assess whether the program was operating as planned (in terms of design, delivery, and utilization) and to identify ways in which the program might need to be strengthened in order to increase its potential for impact. A program theory framework, which laid out the primary components along the hypothesized program impact pathways, was developed in collaboration with HKI and used to design the research. Semistructured interviews and focus group discussions with program beneficiaries (n = 36 and 12, respectively), nonbeneficiaries (n = 12), and program implementers (n = 17 and 2, respectively) and observations of key program delivery points, including health and nutrition training sessions (n = 6), village model farms (n = 6), and household gardens of beneficiaries (n = 36) and nonbeneficiaries (n = 12), were conducted to assess the delivery and utilization of the primary program components along the impact pathways. The majority of program components were being delivered and utilized as planned. However, challenges with some of the key components posited to improve outcomes such as anemia and growth were noted. Among these were a gap in the expected pathway from poultry production to increased intake of eggs and poultry meat, and some weaknesses in the delivery of the health and nutrition training sessions and related improvements in knowledge among the village health volunteers and beneficiaries. Although the program has been successful in delivering the majority of the program

Radiation injury to the nervous system

International Nuclear Information System (INIS)

Gutin, P.H.; Leibel, S.A.; Sneline, G.E.

1991-01-01

This book is designed to describe to the radiation biologist, radiation oncologist, neurologist, neurosurgeon, medical oncologist, and neuro-oncologist, the current state of knowledge about the tolerance of the nervous system to various kinds of radiation, the mechanisms of radiation injury, and how nervous system tolerance and injury are related to the more general problem of radiation damage to normal tissue of all types. The information collected here should stimulate interest in and facilitate the growing research effort into radiation injury to the nervous system

Treatment choices for patients with invasive lobular breast cancer: a doctor survey.

Science.gov (United States)

Jacobs, Carmel; Ibrahim, Mohamed F K; Clemons, Mark; Hutton, Brian; Simos, Demetrios; Caudrelier, Jean-Michel; Graham, Ian D; Smith, Stephanie; Addison, Christina; Arnaout, Angel

2015-08-01

Invasive lobular breast cancer (ILC) has distinct features that present challenges for management. We surveyed doctors regarding management approaches, opinions on quality of evidence supporting their practice, and future research needs. An online questionnaire was developed and circulated to breast cancer surgical, radiation and medical oncologists. The questionnaire was completed by 88/428 doctors (20.6%); 22/56 (39.3%) surgeons, 21/64 (32.8%) radiation oncologists and 45/308 (14.6%) medical oncologists. The majority (65%) of surgeons were comfortable treating ILC patients using the same surgical management as patients with invasive ductal cancers (IDC). Furthermore, 25% would perform a similar surgery but would obtain larger gross margins. There was equipoise for radiation oncologists regarding whether or not ILC was an independent risk factor for local-regional recurrence after either breast-conserving surgery or mastectomy. Of those radiation oncologists who believe ILC is an independent risk factor for recurrence after mastectomy, 44.4% would offer radiation in the absence of usual indications. Medical oncologists approached systemic therapy for ILC patients similarly to those with comparable IDCs. Areas identified as most controversial and requiring future research were preoperative magnetic resonance imaging, radiotherapy post-mastectomy and the responsiveness of ILC to adjuvant chemotherapy compared with endocrine therapy. There is a variation in doctors' beliefs, management and opinions regarding the quality of evidence for the management of ILC. Clinical trials specifically assessing the management of ILC are required to guide clinical practice. © 2015 John Wiley & Sons, Ltd.

Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred?

Science.gov (United States)

Sporn, Nora J; Smith, Kelly B; Pirl, William F; Lennes, Inga T; Hyland, Kelly A; Park, Elyse R

2015-09-01

Sexual health concerns in cancer survivors are often unaddressed by providers. Study objectives were to assess cancer survivors' reported rates of communication with oncology providers about sexual health, preference for such communication with their oncology or primary care providers (PCPs), and factors associated with these communication rates and preferences. Sixty-six patients attending a cancer survivorship clinic were asked how often their oncologist addressed and initiated discussion about sexual functioning and whether they wanted their oncologist or PCP to ask about their sexual health. We also assessed whether various sociodemographic characteristics and levels of depression, anxiety, and sexual satisfaction were associated with survivors' sexual health communication rates and preferences. 41% of patients wanted their oncologist to ask about sexual health and 58% of patients wanted their PCP to ask about sexual health. Over 90% of patients reported that their oncologist infrequently addressed sexual health concerns and that their oncologist was unlikely to initiate such discussions. Education level influenced whether patients wanted their oncologist to ask about sexual health. Age, education level, and insurance type influenced whether patients wanted their PCP to ask about sexual health. Levels of depression, anxiety, and sexual satisfaction were not associated with communication rates or preferences. Patients attending a survivorship clinic reported infrequent communication about sexual health with their oncology providers, despite wanting their providers to ask about sexual health concerns. Copyright © 2014 John Wiley & Sons, Ltd.

Understanding Cancer Prognosis

Medline Plus

Full Text Available ... Your Diagnosis Research Understanding Cancer Prognosis Oncologist Anthony L. Back, M.D., a national expert on doctor- ... Centered Approach View this video on YouTube. Anthony L. Back, M.D., coaches other oncologists about how ...

Evolution of radiation therapy: technology of today

International Nuclear Information System (INIS)

Shrivastava, S.K.; Mishra, Shagun

2013-01-01

The three well established arms of treatment are surgery, radiation therapy and chemotherapy. The management of cancer is multidisciplinary; Radiation Oncologists along with Surgical Oncologists and Medical Oncologists are responsible for cancer therapeutics. They all work in close collaboration with Pathologists and Radiologists for cancer diagnosis and staging and rely on Oncology Nurses, Physiotherapists, Occupational Therapists, Nutritionists and Social Workers for optimal treatment and rehabilitation of cancer patients. Therefore cancer management is a team work for getting the best results. Radiation therapy is one of the most effective methods of treating cancer

Agreement Among RTOG Sarcoma Radiation Oncologists in Contouring Suspicious Peritumoral Edema for Preoperative Radiation Therapy of Soft Tissue Sarcoma of the Extremity

Energy Technology Data Exchange (ETDEWEB)

Bahig, Houda [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, QC (Canada); Roberge, David, E-mail: david.roberge.chum@ssss.gouv.qc.ca [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, QC (Canada); Bosch, Walter [Department of Radiation Oncology, Washington University, St Louis, Missouri (United States); Levin, William [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Petersen, Ivy; Haddock, Michael [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Freeman, Carolyn [Division of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Indelicato, Danny J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Baldini, Elizabeth H. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Hitchcock, Ying [Department of Radiation Oncology, University of Utah Medical Center, Salt Lake City, Utah (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Kozak, Kevin R. [Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States); Wolfson, Aaron [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); and others

2013-06-01

Purpose: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Methods and Materials: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm{sup 3} (7-413 cm{sup 3}), 280 cm{sup 3} and 360 cm{sup 3}. The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm{sup 3} (24-565 cm{sup 3}) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm{sup 3} (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm{sup 3}, respectively. There were 3 large tumors with >30 cm{sup 3} of SE not included in the CTV3cm volume. Conclusion: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant

Agreement among RTOG sarcoma radiation oncologists in contouring suspicious peritumoral edema for preoperative radiation therapy of soft tissue sarcoma of the extremity.

Science.gov (United States)

Bahig, Houda; Roberge, David; Bosch, Walter; Levin, William; Petersen, Ivy; Haddock, Michael; Freeman, Carolyn; Delaney, Thomas F; Abrams, Ross A; Indelicato, Danny J; Baldini, Elizabeth H; Hitchcock, Ying; Kirsch, David G; Kozak, Kevin R; Wolfson, Aaron; Wang, Dian

2013-06-01

Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm(3) (7-413 cm(3)), 280 cm(3) and 360 cm(3). The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm(3) (24-565 cm(3)) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm(3) (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm(3), respectively. There were 3 large tumors with >30 cm(3) of SE not included in the CTV3cm volume. Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE. Copyright © 2013 Elsevier Inc. All rights

Agreement Among RTOG Sarcoma Radiation Oncologists in Contouring Suspicious Peritumoral Edema for Preoperative Radiation Therapy of Soft Tissue Sarcoma of the Extremity

International Nuclear Information System (INIS)

Bahig, Houda; Roberge, David; Bosch, Walter; Levin, William; Petersen, Ivy; Haddock, Michael; Freeman, Carolyn; DeLaney, Thomas F.; Abrams, Ross A.; Indelicato, Danny J.; Baldini, Elizabeth H.; Hitchcock, Ying; Kirsch, David G.; Kozak, Kevin R.; Wolfson, Aaron

2013-01-01

Purpose: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Methods and Materials: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm 3 (7-413 cm 3 ), 280 cm 3 and 360 cm 3 . The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm 3 (24-565 cm 3 ) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm 3 (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm 3 , respectively. There were 3 large tumors with >30 cm 3 of SE not included in the CTV3cm volume. Conclusion: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE

Palliative or curative treatment intent affects communication in radiation therapy consultations.

NARCIS (Netherlands)

Timmermans, L.; Maazen, R.W.M. van der; Leer, J.W.H.; Kraaimaat, F.W.

2006-01-01

OBJECTIVE: To assess whether communication in radiotherapy consultations is affected by palliative or curative treatment intent. SUBJECTS AND METHODS: The study involved 160 patients and 8 radiation oncologists. Eighty patients visited the radiation oncologist (RO) for palliative treatment and 80

Modeling Surface Processes Occurring on Moons of the Outer Solar System

Science.gov (United States)

Umurhan, O. M.; White, O. L.; Moore, J. M.; Howard, A. D.; Schenk, P.

2016-12-01

A variety of processes, some with familiar terrestrial analogs, are known to take place on moon surfaces in the outer solar system. In this talk, we discuss the observed features of mass wasting and surface transport seen on both Jupiter's moon Calisto and one of Saturn's Trojan moons Helene. We provide a number of numerical models using upgraded version of MARSSIM in support of several hypotheses suggested on behalf of the observations made regarding these objects. Calisto exhibits rolling plains of low albedo materials surrounding relatively high jutting peaks harboring high albedo deposits. Our modeling supports the interpretation that Calisto's surface is a record of erosion driven by the sublimation of CO2 and H2O contained in the bedrock. Both solar insolation and surface re-radiation drives the sublimation leaving behind debris which we interpret to be the observed darkened regolith and, further, the high albedo peaks are water ice deposits on surface cold traps. On the other hand, the 45 km scale Helene, being a milligravity environment, exhibits mysterious looking streaks and grooves of very high albedo materials extending for several kilometers with a down-sloping grade of 7o-9o. Helene's cratered terrain also shows evidence of narrowed septa. The observed surface features suggest some type of advective processes are at play in this system. Our modeling lends support to the suggestion that Helene's surface materials behave as a Bingham plastic material - our flow modeling with such rheologies can reproduce the observed pattern of streakiness depending upon the smoothness of the underlying bedrock; the overall gradients observed; and the narrowed septa of inter-crater regions.

The future of radiation oncology in the United States from 2010 to 2020: will supply keep pace with demand?

Science.gov (United States)

Smith, Benjamin D; Haffty, Bruce G; Wilson, Lynn D; Smith, Grace L; Patel, Akshar N; Buchholz, Thomas A

2010-12-10

Prior studies forecasted an incipient shortage of medical oncologists as a result of the aging US population, but the radiation oncology workforce has not been studied. Accordingly, we projected demand for radiation therapy and supply of radiation oncologists in 2010 and 2020 to determine whether a similar shortage may exist for this specialty. Demand for radiation therapy in 2010 and 2020 was estimated by multiplying current radiation utilization rates (as calculated with Surveillance, Epidemiology, and End Results data) by population projections from the Census Bureau. Supply of radiation oncologists was projected using data from the American Board of Radiology inclusive of current radiation oncologists and active residents, accounting for variation in full-time equivalent status and expected survival by age and sex. Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand. Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Personal values and cancer treatment refusal

NARCIS (Netherlands)

Evert van Leeuwen; Marli Huijer

2000-01-01

This pilot study explores the reasons patients have for refusing chemotherapy, and the ways oncologists respond to them. Our hypothesis, generated from interviews with patients and oncologists, is that an ethical approach that views a refusal as an autonomous choice, in which patients are informed

5S-menetelmän implementointi

OpenAIRE

Kaikula, Kari-Marko

2017-01-01

Tässä opinnäytetyössä tavoiteltiin siisteyden ja järjestyksen tuomista 5S-menetelmän avulla Helen Oy:n kunnossapidon varaosavarastoon Salmisaaren voimalaitoksella. Helen Oy on Helsingin kaupungin omistama energia-alan yritys. Kehittämistehtävänä työssä oli 5S-menetelmän implementointi. Tutkimuksen tarkoituksena oli tutkia niitä seikkoja, jotka vaikuttavat 5S-menetelmän käyttöönottoon. 5S on menetelmä, jolla tuodaan siisteyttä ja järjestystä työympäristöön. Tutkimusmenetelmänä oli toiminta...

A Call for New Communication Channels for Gynecological Oncology Trainees: A Survey on Social Media Use and Educational Needs by the European Network of Young Gynecological Oncologists.

Science.gov (United States)

Zalewski, Kamil; Lindemann, Kristina; Halaska, Michael J; Zapardiel, Ignacio; Laky, Rene; Chereau, Elisabeth; Lindquist, David; Polterauer, Stephan; Sukhin, Vladislav; Dursun, Polat

2017-03-01

The aim of the study was to assess patterns in the use of social media (SM) platforms and to identify the training needs among European gynecologic oncology trainees. In 2014, a web-based survey was sent to 633 trainees from the European Network of Young Gynaecological Oncologists (ENYGO) database. The 14-item questionnaire (partially using a 1- to 5-point Likert scale) assessed respondents' use of SM and preference for workshop content and organization. Descriptive analysis was used to describe the mean scores reported for different items, and the internal reliability of the questionnaire was assessed by Cronbach α. In total, 170 ENYGO members (27%) responded to the survey. Of those, 91% said that they use SM platforms, mostly for private purposes. Twenty-three percent used SM professionally and 43% indicated that they would consider SM to be a clinical discussion forum. The respondents said that they would like updates on conferences and professional activities to be shared on SM platforms. Complication management, surgical anatomy, and state of the art in gynecologic oncology were identified as preferred workshops topics. The most frequently indicated hands-on workshops were laparoscopic techniques and surgical anatomy. Consultants attached a higher level of importance to palliative care education and communication training than trainees. The mean duration of the workshop preferred was 2 days. This report highlights the significance of ENYGO trainees' attachment to SM platforms. Most respondents expect ENYGO to use these online channels for promoting educational activities and other updates. Using SM for clinical discussion will require specific guidelines to secure professional and also consumer integrity. This survey confirms surgical management and the state of the art as important knowledge gaps, and ENYGO has tailored its activities according to these results. Future activities will further direct attention and resources to education in palliative care and

Cyclic pressurisation of Mount St Helens dacites and basalt. Laboratory results and implications for lava dome monitoring

Science.gov (United States)

Kendrick, Jackie; Dainty, Matthew; Smith, Rosanna; Sammonds, Peter; Pallister, John; Meredith, Phillip

2010-05-01

Lava domes are frequently subjected to cyclic heating and pressurisation, which may weaken the dome rocks, leading to renewed extrusion, explosions or collapse. These heating and loading cycles can be recreated in the laboratory, allowing the level of crack damage caused by these cycles to be established through analysing elastic moduli. Acoustic emissions (AEs) indicate the timing of cracking, and can also be used to interpret precursory seismicity for eruption prediction. Experiment samples are from Mount St. Helens, USA: 3 dacites from the Pine Creek eruptive period (2.9-2.55 ka), a Castle Creek age basalt (2.55-1.895 ka), and 4 dacites from the 2004-2008 eruption. Each sample was cut into several cylindrical cores (25 mm diameter and 62.5-70 mm long). Some samples were then heated and cooled at 1˚C/ minute to a target temperature of 600o C or 900o C, and held for 2 hours to achieve thermal equilibrium. This heating can cause cracking due to contrasts in thermal expansion of different minerals. Dynamic elastic moduli were calculated for each sample using ultrasonic wave velocity, density and porosity for later comparison to static elastic moduli gathered during deformation. One core of each sample was loaded to failure in uniaxial compression in order to find the short term strength of the sample. For all cyclic loading tests, conducted on pre-heated and unheated cores, samples were loaded at 10-5 s-1 strain rate then unloaded to 5MPa. Subsequent cycles had an increasing peak load. Most had the same rate for unloading, with a few samples unloaded instantaneously. Axial, radial and volumetric strain were determined from the recorded displacement throughout the experiment and used with the axial stress measurements to calculate static elastic moduli. Samples loaded to failure with no cycling generally failed at higher stresses than their cyclically loaded counter-parts, whilst rapid unloading increased their strength. Failure stresses of the dacite lava dome

Multidisciplinary approach of early breast cancer: The biology applied to radiation oncology

International Nuclear Information System (INIS)

Bourgier, Céline; Ozsahin, Mahmut; Azria, David

2010-01-01

Early breast cancer treatment is based on a multimodality approach with the application of clinical and histological prognostic factors to determine locoregional and systemic treatments. The entire scientific community is strongly involved in the management of this disease: radiologists for screening and early diagnosis, gynecologists, surgical oncologists and radiation oncologists for locoregional treatment, pathologists and biologists for personalized characterization, genetic counselors for BRCA mutation history and medical oncologists for systemic therapies. Recently, new biological tools have established various prognostic subsets of breast cancer and developed predictive markers for miscellaneous treatments. The aim of this article is to highlight the contribution of biological tools in the locoregional management of early breast cancer

Olelusvõitlus bioloogiarindel / Helen Urbanik

Index Scriptorium Estoniae

Urbanik, Helen

2002-01-01

Ameerika koolides tahetakse lastele darvinismi asemel õpetada teooriat, mis ei püüagi elu tekkimist Maal selgitada. Mõtteviisist, mida nimetatakse mõistuspärase loomise teooriaks (intelligent design theory ehk lühidalt ID teooria)

Multielemental analyses of tree rings by inductively coupled plasma mass spectrometry

International Nuclear Information System (INIS)

Hall, G.S.

1990-01-01

Inductively coupled plasma mass spectrometry (ICP-MS) was evaluated for major, minor, trace, and ultra-trace elemental analyses of individual tree rings. The samples were obtained from an old-growth Douglas fir growing near Mount St. Helens volcano, and from trees at various other North American sites. Eightly percent of elements from Li to U had detection limits in the solid (wood) below 8.0 ng g -1 . Two anomalous peaks occur in Mount St. Helens samples at A.D. 1478 and 1490 that closely correlate with past eruptions of the volcano. These results show that ICP-MS is a rapid and sensitive analytical method for multielemental analyses of individual tree rings. (author) 16 refs.; 2 figs.; 2 tabs

Pärleid vanapaberi hulgast : kohtumisi inimeste ja vanaraamatuga / Uno Schultz

Index Scriptorium Estoniae

Schultz, Uno, 1956-

2010-01-01

Bibliofiil Uno Schultzi vanaraamatute kogu kujunemisest ning inimestest, kellega haruldaste raamatute leidmisel kohtutud, sh Kyra Robertist, Voldemar Millerist, Trivimi Vellistest, Oskar Kuningast, Helene Kulpast, Erik Tederist jt.

Faculty of Radiation Oncology 2010 workforce survey.

Science.gov (United States)

Leung, John; Vukolova, Natalia

2011-12-01

This paper outlines the key results of the Faculty of Radiation Oncology 2010 workforce survey and compares these results with earlier data. The workforce survey was conducted in mid-2010 using a custom-designed 17-question survey. The overall response rate was 76%. The majority of radiation oncologist respondents were male (n = 212, 71%), but the majority of trainee respondents were female (n = 59, 52.7%). The age range of fellows was 32-92 years (median: 47 years; mean: 49 years) and that of trainees was 27-44 years (median: 31 years; mean: 31.7 years). Most radiation oncologists worked at more than one practice (average: two practices). The majority of radiation oncologists worked in the public sector (n = 169, 64.5%), with some working in 'combination' of public and private sectors (n = 65, 24.8%) and a minority working in the private sector only (n = 28, 10.7%). The hours worked per week ranged from 1 to 85 (mean: 44 h; median: 45 h) for radiation oncologists, while for trainees the range was 16-90 (mean: 47 h; median: 45 h). The number of new cases seen in a year ranged from 1 to 1100 (mean: 275; median: 250). Most radiation oncologists considered themselves generalists with a preferred sub-specialty (43.3%) or specialists (41.9%), while a minority considered themselves as generalists (14.8%). There are a relatively large and increasing number of radiation oncologists and trainees compared with previous years. The excessive workloads evident in previous surveys appear to have diminished. However, further work is required on assessing the impact of ongoing feminisation and sub-specialisation. © 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.

Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists.

Science.gov (United States)

Rodenbach, Rachel A; Brandes, Kim; Fiscella, Kevin; Kravitz, Richard L; Butow, Phyllis N; Walczak, Adam; Duberstein, Paul R; Sullivan, Peter; Hoh, Beth; Xing, Guibo; Plumb, Sandy; Epstein, Ronald M

2017-03-10

Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions.

Ruumieksperiment nimega Arhitektuurikatel = A spatial experiment called Arhitektuurikatel (Architecture Hub) / Artur Ümar, Tõnu Laigu

Index Scriptorium Estoniae

Ümar, Artur

2014-01-01

Arhitektuurikatel Tallinnas Põhja puiesteel. Arhitektuur: Tõnu Laigu, Koit Ojaliiv (QP Arhitektid), võistlusel osalesid ka Helen Rebane ja Triinu Silla. Sisearhitektuur: Andres Labi, Janno Roos (Ruumilabor). Valmimisaasta: 2013

Practical consensus recommendations on fertility preservation in patients with breast cancer

Directory of Open Access Journals (Sweden)

Jyoti Bajpai

2018-01-01

Full Text Available Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

Mati Undi teater revisited / Luule Epner

Index Scriptorium Estoniae

Epner, Luule, 1953-

2009-01-01

Teatrilavastuste taastamisest üldisemalt. Pikemalt festivali UNT! programmis etendunud Mati Undi lavastustest "Majahoidja", "Vaimude tund Jannseni tänaval", "Helene, Marion ja Felix", originaali ja taastatud variandi võrdlus

Krokodill sõi karu mett / Eero Kangor

Index Scriptorium Estoniae

Kangor, Eero, 1982-

2007-01-01

Tartu Ülikooli, Tartu Kõrgema Kunstikooli ja Tartu Kunstikooli õpilaste näitusest Tartu Kunstimuuseumis, kuraator Liisa Kaljula. Pikemalt Ronald Baumanni, Helen Kikkase, Margit Lõhmuse maalidest, Jana Huuli skulptuurist

Naisfotograafid, kes avavad meie silmad / Katie Breen

Index Scriptorium Estoniae

Breen, Katie

2008-01-01

Fotograafid Ami Vitale, Helene David, Stephanie Sinclair, Lauren Greenfield, Deirdre Brennan, Veronique de Viguerie, Christine Spengler pildistavad võõraid kultuure Aafrikas, Alaskal, Afganistanis, Iraagis. 9 fotot. Portreefotod fotograafidest

Elizabeth II üle Diana ja Tony / Kristiina Davidjants

Index Scriptorium Estoniae

Davidjants, Kristiina, 1974-

2007-01-01

Stephen Frearsi mängufilm "Kuninganna" ("The Queen") : stsenarist Peter Morgan : kuninganna Elizabeth II kehastab Helen Mirren peaminister Tony Blair'i Michael Sheen: Suurbritannia - Ameerika Ühendriigid - Itaalia 2006

Oncologists’ Perspectives on Consolidation Radiation Treatment after Chemotherapy for Lymphomas: A Survey Study by the Lymphoma Working Committee of the Turkish Oncology Group (TOG)

Science.gov (United States)

Tanriverdi, Ozgur; Barista, Ibrahim; Paydas, Semra; Nayir, Erdinc; Karakas, Yusuf

2017-11-26

In this study, we aimed to determine the perspectives of medical and radiation oncologists regarding consolidation radiotherapy in patients with a complete response after chemotherapy for Hodgkin’s and non-Hodgkin’s lymphomas. The survey was designed to identify demographic and occupational features of medical and radiation oncologists and their views on application of consolidation radiotherapy in their clinical practices, as based on a five-point Likert scale (never, rarely, sometimes, often, and always). The study covered 263, out of 935, physicians working in the oncology field as either medical or radiation oncologists; the rate of return on the invitations to participate was 28%. The majority of the participants were male radiation oncologists, with a duration of between 5 and 10 years of work as a university hospital official, and the mean age was 38 ± 14 (years). Although the most commonly followed international guidelines were NCCN, among the physicians, the majority of the respondents suggested that the guidelines were unclear regarding recommendations for consolidative radiotherapy. The administered dose for consolidative radiotherapy in lymphoma patients was indicated as 40 Gy by 49% of all the physicians and the most common cause of hesitancy concerning consolidative radiation treatment was the risk of secondary malignancies as a long-term adverse effect (54%). In conclusion, we suggest that medical oncologists could be most active in the treatment of lymphoma through a continuous training program about lymphomas and current national guidelines. Creative Commons Attribution License

Interrelations among pyroclastic surge, pyroclastic flow, and lahars in Smith Creek valley during first minutes of 18 May 1980 eruption of Mount St. Helens, USA

Science.gov (United States)

Brantley, S.R.; Waitt, R.B.

1988-01-01

A devastating pyroclastic surge and resultant lahars at Mount St. Helens on 18 May 1980 produced several catastrophic flowages into tributaries on the northeast volcano flank. The tributaries channeled the flows to Smith Creek valley, which lies within the area devastated by the surge but was unaffected by the great debris avalanche on the north flank. Stratigraphy shows that the pyroclastic surge preceded the lahars; there is no notable "wet" character to the surge deposits. Therefore the lahars must have originated as snowmelt, not as ejected water-saturated debris that segregated from the pyroclastic surge as has been inferred for other flanks of the volcano. In stratigraphic order the Smith Creek valley-floor materials comprise (1) a complex valley-bottom facies of the pyroclastic surge and a related pyroclastic flow, (2) an unusual hummocky diamict caused by complex mixing of lahars with the dry pyroclastic debris, and (3) deposits of secondary pyroclastic flows. These units are capped by silt containing accretionary lapilli, which began falling from a rapidly expanding mushroom-shaped cloud 20 minutes after the eruption's onset. The Smith Creek valley-bottom pyroclastic facies consists of (a) a weakly graded basal bed of fines-poor granular sand, the deposit of a low-concentration lithic pyroclastic surge, and (b) a bed of very poorly sorted pebble to cobble gravel inversely graded near its base, the deposit of a high-concentration lithic pyroclastic flow. The surge apparently segregated while crossing the steep headwater tributaries of Smith Creek; large fragments that settled from the turbulent surge formed a dense pyroclastic flow along the valley floor that lagged behind the front of the overland surge. The unusual hummocky diamict as thick as 15 m contains large lithic clasts supported by a tough, brown muddy sand matrix like that of lahar deposits upvalley. This unit contains irregular friable lenses and pods meters in diameter, blocks incorporated from

21. X avati Kaunase kunstibiennaal "Textile 2005"

Index Scriptorium Estoniae

2005-01-01

Eestist osalevad Mare Kelpmann, Marika Kööbi, Aet Ollisaar, Kadi Pajupuu, Ludmilla Svarzhevska, Hanna Tiidus, Helen Kauksi, Krista Leesi, Aune Taamal, Erika Tammpere, Milvi Thalheim ja Erle Võsa-Tangsoo

Applying Strategic Management in the Office of the Assistant Secretary of the Army for Financial Management and Comptroller (ASA(FM&C))

National Research Council Canada - National Science Library

Sturek, Frank

2000-01-01

The Assistant Secretary of the Army for Financial Management and Comptroller (ASA(FM&C)), the Honorable Mrs. Helen T. McCoy, started an organizational performance improvement initiative in September 1999...

Belgia printsessi tervitatakse "Everybody" viisile tehtud lauluga

Index Scriptorium Estoniae

2001-01-01

Belgia kroonprintsessi Mathilde tõi eelmisel nädalal ilmale tütre, kelle nimeks on Elisabeth Therese Marie Helene. Belgia pensionärid tervitasid kroonprintsessi eesti eurolaulu viisile tehtud lauluga

Rahvuslikus stiilis lastetuba meeldis nii asjatundjatele kui ka publikule / Siret Mägi

Index Scriptorium Estoniae

Mägi, Siret

2007-01-01

Tallinna Mustika ostukeskuses kuulutati välja sisekujunduskonkursi "Rahvuslik tuba" võitjad. Parimaks tunnistati Eva Herrera, II koha pälvis Gudrun Vung ning III koha Helen Sarapuu ja Katrin Rooger

"Gerontiuse unenägu" Estonias / Igor Garšnek

Index Scriptorium Estoniae

Garšnek, Igor, 1958-

2010-01-01

2. aprillil Estonia kontserdisaalis toimunud Edward Elgari oratooriumi "Gerontiuse unenägu" ettekandest, esitasid: ERSO, Estonia ooperikoor, Estonia poistekoor, kammerkoor Voces Musicales, Helen Lokuta, Bernhard Gärtner, Priit Volmer, dirigent Carlos Spiereri

Resenha: Power, Interdependence and Nonstate Actors in World Politics

Directory of Open Access Journals (Sweden)

Katiuscia Moreno Galhera Espósito

2011-10-01

Full Text Available Resenha do livro: Moravcsik, Andrew; Milner, Helen V. (org.. Power, Interdependence and Nonstate Actors in World Politics. New Jersey: Princeton University Press, 2009. ISBN 978-0-691-14027-8

Нарвский киноэкран станет окном в Лондонский театр

Index Scriptorium Estoniae

2009-01-01

25. juunil stardib Forum Cinemas keti kinodes pilootprojekt, kus linale jõuab otseülekanne Londoni Rahvusteatri etendusest "Phaidra", lavastaja Nicholas Hytner, peaosas Helen Mirren. Projektis osaleb ka Narva kino Forum Cinemas Astri

Soome kirikudisain, Schjerfbecki autoportreed, Mucha juugend / Harry Liivrand

Index Scriptorium Estoniae

Liivrand, Harry, 1961-

2006-01-01

Näitus "Tuvi ja tall - Helsingi kirikute sakraalne disain" Helsingi disainimuuseumis. Helene Schjerfbecki (1862-1946) näitus Didrichseni kunstimuuseumis. Alphonse Mucha (1860-1939) ehete ja teatriplakatite näitus Amos Andersoni Taidemuseumis

Volcanoes: Coming Up from Under.

Science.gov (United States)

Science and Children, 1980

1980-01-01

Provides specific information about the eruption of Mt. St. Helens in March 1980. Also discusses how volcanoes are formed and how they are monitored. Words associated with volcanoes are listed and defined. (CS)

Variation in Adherence to External Beam Radiotherapy Quality Measures Among Elderly Men With Localized Prostate Cancer

International Nuclear Information System (INIS)

Bekelman, Justin E.; Zelefsky, Michael J.; Jang, Thomas L.; Basch, Ethan M.; Schrag, Deborah

2007-01-01

Purpose: To characterize the variation in adherence to quality measures of external beam radiotherapy (EBRT) for localized prostate cancer and its relation to patient and provider characteristics in a population-based, representative sample of U.S. men. Methods and Materials: We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged ≥65 years diagnosed between 2000 and 2002 with localized prostate cancer and treated with primary EBRT using data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare program. We assessed the adherence to five EBRT quality measures that were amenable to analysis using SEER-Medicare data: (1) use of conformal RT planning; (2) use of high-energy (>10-MV) photons; (3) use of custom immobilization; (4) completion of two follow-up visits with a radiation oncologist in the year after therapy; and (5) radiation oncologist board certification. Results: Of the 11,674 patients, 85% had received conformal RT planning, 75% had received high-energy photons, and 97% had received custom immobilization. One-third of patients had completed two follow-up visits with a radiation oncologist, although 91% had at least one visit with a urologist or radiation oncologist. Most patients (85%) had been treated by a board-certified radiation oncologist. Conclusions: The overall high adherence to EBRT quality measures masked substantial variation in geography, socioeconomic status in the area of residence, and teaching affiliation of the RT facility. Future research should examine the reasons for the variations in these measures and whether the variation is associated with important clinical outcomes

Adjuvant therapy decisions based on magnetic resonance imaging of extramural venous invasion and other prognostic factors in colorectal cancer

Science.gov (United States)

Swift, RI; Chau, I; Heald, RJ; Tekkis, PP; Brown, G

2014-01-01

Introduction There remains a lack of high quality randomised trial evidence for the use of adjuvant chemotherapy in stage II rectal cancer, particularly in the presence of high risk features such as extramural venous invasion (EMVI). The aim of this study was to explore this issue through a survey of colorectal surgeons and gastrointestinal oncologists. Methods An electronic survey was sent to a group of colorectal surgeons who were members of the Association of Coloproctology of Great Britain and Ireland. The survey was also sent to a group of gastrointestinal oncologists through the Pelican Cancer Foundation. Reminder emails were sent at 4 and 12 weeks. Results A total of 142 surgeons (54% response rate) and 99 oncologists (68% response rate) responded to the survey. The majority in both groups of clinicians thought EMVI was an important consideration in adjuvant treatment decision making and commented routinely on this in their multidisciplinary team meeting. Although both would consider treating patients on the basis of EMVI detected by magnetic resonance imaging, oncologists were more selective. Both surgeons and oncologists were prepared to offer patients with EMVI adjuvant chemotherapy but there was lack of consensus on the benefit. Conclusions This survey reinforces the evolution in thinking with regard to adjuvant therapy in stage II disease. Factors such as EMVI should be given due consideration and the prognostic information we offer patients must be more accurate. Historical data may not accurately reflect today’s practice and it may be time to consider an appropriately designed trial to address this contentious issue. PMID:25245736

High-resolution digital elevation model of lower Cowlitz and Toutle Rivers, adjacent to Mount St. Helens, Washington, based on an airborne lidar survey of October 2007

Science.gov (United States)

Mosbrucker, Adam

2015-01-01

The lateral blast, debris avalanche, and lahars of the May 18th, 1980, eruption of Mount St. Helens, Washington, dramatically altered the surrounding landscape. Lava domes were extruded during the subsequent eruptive periods of 1980–1986 and 2004–2008. More than three decades after the emplacement of the 1980 debris avalanche, high sediment production persists in the Toutle River basin, which drains the northern and western flanks of the volcano. Because this sediment increases the risk of flooding to downstream communities on the Toutle and lower Cowlitz Rivers, the U.S. Army Corps of Engineers (USACE), under the direction of Congress to maintain an authorized level of flood protection, continues to monitor and mitigate excess sediment in North and South Fork Toutle River basins to help reduce this risk and to prevent sediment from clogging the shipping channel of the Columbia River. From October 22–27, 2007, Watershed Sciences, Inc., under contract to USACE, collected high-precision airborne lidar (light detection and ranging) data that cover 273 square kilometers (105 square miles) of lower Cowlitz and Toutle River tributaries from the Columbia River at Kelso, Washington, to upper North Fork Toutle River (below the volcano's edifice), including lower South Fork Toutle River. These data provide a digital dataset of the ground surface, including beneath forest cover. Such remotely sensed data can be used to develop sediment budgets and models of sediment erosion, transport, and deposition. The U.S. Geological Survey (USGS) used these lidar data to develop digital elevation models (DEMs) of the study area. DEMs are fundamental to monitoring natural hazards and studying volcanic landforms, fluvial and glacial geomorphology, and surface geology. Watershed Sciences, Inc., provided files in the LASer (LAS) format containing laser returns that had been filtered, classified, and georeferenced. The USGS produced a hydro-flattened DEM from ground-classified points at

Referral and Receipt of Treatment for Hepatocellular Carcinoma in United States Veterans: Effect of Patient and Non-Patient Factors

Science.gov (United States)

Davila, Jessica A.; Kramer, Jennifer R.; Duan, Zhigang; Richardson, Peter A.; Tyson, Gia L.; Sada, Yvonne H.; Kanwal, Fasiha; El-Serag, Hashem B.

2014-01-01

Background The delivery of treatment for hepatocellular carcinoma (HCC) could be influenced by place of HCC diagnosis (hospitalization vs. outpatient), subspecialty referral following diagnosis, as well as physician and facility factors. We conducted a study to examine the effect of patient and non-patient factors on the place of HCC diagnosis, referral, and treatment in Veterans Administration (VA) hospitals in the United States. Methods Using the VA Hepatitis C Clinical Case Registry, we identified HCV-infected patients who developed HCC during 1998–2006. All cases were verified and staged according to Barcelona Clinic Liver Cancer (BCLC) criteria. The main outcomes were place of HCC diagnosis, being seen by a surgeon or oncologist, and treatment. We examined factors related to these outcomes using hierarchical logistic regression. These factors included HCC stage, HCC surveillance, physician specialty, and facility factors, in addition to risk factors, co-morbidity, and liver disease indicators. Results Approximately 37.2% of the 1,296 patients with HCC were diagnosed during hospitalization, 31.0% were seen by a surgeon or oncologist, and 34.3% received treatment. Being seen by a surgeon or oncologist was associated with surveillance (adjusted odds ratio (aOR)=1.47;95%CI:1.20–1.80) and varied by geography (1.74;1.09–2.77). Seeing a surgeon or oncologist was predictive of treatment (aOR=1.43;95%CI:1.24–1.66). There was a significant increase in treatment among patients who received surveillance (aOR=1.37; 95%CI:1.02–1.71), were seen by gastroenterology (1.65;1.21–2.24) or were diagnosed at a transplant facility (1.48;1.15–1.90). Conclusions Approximately 40% of patients were diagnosed during hospitalization. Most patients were not seen by a surgeon or oncologist for treatment evaluation and only 34% received treatment. Only receipt of HCC surveillance was associated with increased likelihood of outpatient diagnosis, being seen by a surgeon or

The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians.

Science.gov (United States)

Emanuel, E J; Daniels, E R; Fairclough, D L; Clarridge, B R

1998-08-12

Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States. To determine whether the practices of euthanasia and PAS are consistent with proposed safeguards and the effect on physicians of having performed euthanasia or PAS. Structured in-depth telephone interviews. Randomly selected oncologists in the United States. Adherence to primary and secondary safeguards for the practice of euthanasia and PAS; regret, comfort, and fear of prosecution from performing euthanasia or PAS. A total of 355 oncologists (72.6% response rate) were interviewed on euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care. Physicians sought consultation in 15 cases (39.5%). Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%): (1) having the patient initiate and repeat the request for euthanasia or PAS, (2) ensuring the patient was experiencing extreme physical pain or suffering, and (3) consulting with a colleague. Those who adhered to the safeguards had known their patients longer and tended to be more religious. In 28 cases (73.7%), the family supported the decision. In all cases of pain, patients were receiving narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While 19 oncologists (52.6%) received comfort from having helped a patient with euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS, and

Bereaved Employee: Returning to Work

Science.gov (United States)

... Work Working Through Grief About Us The Bereaved Employee: Returning to Work By Helen Fitzgerald, CT After ... One employer called a grief therapist to help employees after a co-worker reported the death of ...

Novel competition 2015 : clowns and schoolboys, not to mention a footballer in love / Kärt Hellerma

Index Scriptorium Estoniae

Hellerma, Kärt, 1956-

2015-01-01

Eesti Kirjanike Liidu korraldatud romaanivõistluse võitis Armin Kõomägi romaaniga "Lui Vutoon", 2. koha sai Märt Lauri "Lahustumine", 3. koha Jim Ashilevi "Kehade mets" ning 4. koha Helen Eelranna "Suluseis"

Gorgias' and Isocrates' Use of the Encomium.

Science.gov (United States)

Poulakos, John

1986-01-01

Suggests that during the fifth and fourth centuries B.C. the encomium was not a rigid rhetorical genre, but a normative type both stable and elastic. Compares Gorgias and Isocrates' encomia of Helen. (MS)

Letters What causes an ice skater to accelerate? Note on the definitions of weight A-level physics is mathematical enough Correction to 'Confusion over the physics of circular motion'

Science.gov (United States)

2011-11-01

What causes an ice skater to accelerate? Hugh Fricker Note on the definitions of weight Nenad Stojilovic A-level physics is mathematical enough Helen Hare Correction to 'Confusion over the physics of circular motion'

Ajalooga aiad ja moodne harmoonia / Urmas Grishakov

Index Scriptorium Estoniae

Grišakov, Urmas, 1942-2013

2007-01-01

IT-firmade tehnopargist City West Business Campus (maastikulahendus: Martin Halliman), Saint Fiachari aiast, maastikuplaneerija William Robinsoni aiast, eraaiast Dublini eeslinnas Foxrockis (maastikuaednik Damian Keane), Helen Dilloni aiast Sandyford Roadil ja Killruddery lossipargist (1682) Iirimaal

"Hall mees" Linnateatris / Triin Sinissaar

Index Scriptorium Estoniae

Sinissaar, Triin

1999-01-01

Tallinn Linnateatri ja Raadioteatri ühislavastus "Hall mees" Gill Adamsi näidendi järgi, lavastaja Eero Spriit, osades Helene Vannari ja Väino Laes, kunstnik Kustav - Agu Püüman. Esietendus 22. okt

Uuslavastused Ugalas / Helle Leppik

Index Scriptorium Estoniae

Leppik, Helle

2007-01-01

Ugalas käib töö nelja uuslavastusega : Ott Aardam lavastab "Börs ja Börsitar", Helen Rekkor toob lavale "Nora/Maja", Peeter Tammearu suvelavastus on "Sirelikassid" ja Margus Vaher lavastab suvelavastuse "Naabri Mari"

Randomised controlled trial of the efficacy of misoprostol used as a ...

African Journals Online (AJOL)

Randomised controlled trial of the efficacy of misoprostol used as a cervical ripening agent prior to termination of pregnancy in the first trimester. Eric T M de Jonge, Rachel Jewkes, Jonathan Levin, Helen Rees ...

"Nimed marmortahvlil 2" ootab tegemist / Mihkel Raud

Index Scriptorium Estoniae

Raud, Mihkel, 1969-

2006-01-01

Stephen Frearsi mängufilm "Kuninganna" ("The Queen") : stsenarist Peter Morgan : kuninganna Elizabeth II kehastab Helen Mirren : Suurbritannia - Ameerika Ühendriigid - Itaalia 2006. Irooniline vihje teha ka Eestis poliitilise eliidi lepitamiseks rahvaga esimestest melodramaatilisi filme

Ascetismo, gênero e poder no Baixo Império Romano: Paládio de Helenópolis e o status das devotas cristãs Asceticism, gender and power in the Late Roman Empire: Palladius and the status of the holy women

Directory of Open Access Journals (Sweden)

Gilvan Ventura da Silva

2007-01-01

Full Text Available As diversas modalidades de ascetismo feminino que vigoraram nas comunidades cristãs ao longo dos três primeiros séculos do Império tenderão a se integrar numa nova experiência religiosa que começa a se esboçar por volta de 270 para alcançar uma expansão considerável no final do Mundo Antigo: o monacato. Mediante a análise da História Lausíaca, de Paládio de Helenópolis, obra escrita por volta de 420, investigamos a posição social das ascetas e o tipo de atuação que desempenharam no interior de um movimento dominado pelos homens, como foi o movimento monástico. Além disso, analisamos a capacidade das mulheres de exercer alguma modalidade de poder no âmbito das suas comunidades locais em comparação aos homens divinos cristãos do Baixo Império.The several kinds of female asceticism observed in the Roman Empire during the first three centuries A.D. will be gathered in a new religious experience that begins around 270 A.D.: the monasticism. Throughout the analysis of the Lausiac History, written by Palladius, bishop of Hellenopolis, in Bitinia, we aim at researching about the female ascetics social position and their actions as monastic movement members. Besides, we reflect over the kind of power women could exercise in their local communities compared with the holy men.

Oncologists partner with Watson on genomics.

Science.gov (United States)

2015-08-01

A new collaboration between IBM Watson Health and more than a dozen cancer centers uses the power of cognitive computing to dramatically reduce the time it takes to analyze data from patients' DNA and identify targeted treatment options. ©2015 American Association for Cancer Research.

Bringing Precision Medicine to Community Oncologists.

Science.gov (United States)

2017-01-01

Quest Diagnostics has teamed up with Memorial Sloan Kettering Cancer Center and IBM Watson Health to offer IBM Watson Genomics to its network of community cancer centers and hospitals. This new service aims to advance precision medicine by combining genomic tumor sequencing with the power of cognitive computing. ©2017 American Association for Cancer Research.

Veterinary Oncologist | Center for Cancer Research

Science.gov (United States)

The NCI is implementing a program intended to connect and closely coordinate the Division of Cancer Treatment and Diagnosis’ (DCTD’s) immunotherapeutics and other drug development activities with the translational oriented clinical trials of the Center for Cancer Research’s (CCR’s) Comparative Oncology Program (COP), especially the treatment of dogs with natural occurring

Jaapani meditatsiooni, erootikat ja vägivalda / Margit Adorf

Index Scriptorium Estoniae

Adorf, Margit, 1974-

2011-01-01

Tallinna Kinomajas 25.-28. aug.-ni toimuvast Aasia sõltumatute filmide festivalist EVA - East via Asia. Festivali korraldaja Helen Merila. Festival sündis koostöös Zipangu Fest Japananarchy in UK peakorraldaja Jasper Sharpiga

Factors associated with the receipt of fertility preservation services along the decision-making pathway in young Canadian female cancer patients.

Science.gov (United States)

Yee, Samantha

2016-02-01

This study investigated the factors associated with the receipt of fertility preservation (FP) services along the decision-making pathway in young Canadian female cancer patients. The roles of the oncologists were examined. A total of 188 women who were diagnosed with cancer between the ages of 18-39 after the year 2000 and had finished active cancer treatment by the time of the survey (2012-2013) participated in the study. Logistic regression models and Pearson χ (2) tests were used for analyses. The mean ages of participants at diagnosis and at survey time were 30.2 (SD = 3.7) and 33.9 (SD = 5.9). One quarter (n = 45, 23.9 %) did not recall having a fertility discussion with their oncologists. Of the three quarters who had a fertility discussion (n = 143, 76.1 %), discussions were equally initiated by oncologists (n = 71) and patients (n = 72). Of the 49 women (26 %) who consulted a fertility specialist, 17 (9 %) underwent a FP procedure. Fertility concern at diagnosis was the driving force of the receipt of FP services at all decision points. Our findings suggest that not only was the proactive approach of oncologists in initiating a fertility discussion important, the quality of the discussion was equally critical in the decision-making pathway. Oncologists play a pivotal role in the provision of fertility services in that they are not only gate keepers, knowledge brokers, and referral initiators of FP consultation, but also they are catalysts in supporting cancer patients making important FP decision in conjunction with the consultation provided by a fertility specialist.

Does Specialty Bias Trump Evidence in the Management of High-risk Prostate Cancer?

Science.gov (United States)

Kishan, Amar U; Duchesne, Gillian; Wang, Pin-Chieh; Rwigema, Jean-Claude M; Saigal, Christopher; Rettig, Matthew; Steinberg, Michael L; King, Christopher R

2018-06-01

The objective was to query how specialty influences treatment recommendations for high-risk prostate cancer in 3 clinical settings: upfront management, postoperative management, and management of biochemical recurrences (BCRs) after radiotherapy (RT). We hypothesized that specialty bias would manifest in all settings, trumping available evidence. A survey of practicing urologists and radiation oncologists was distributed through electronic mail. Questions pertained to upfront management, postoperative treatment, and local salvage for postradiation BCRs. The associations between 26 selected categorical responses and specialty were assessed using multivariate logistic regression. Training level/expertise, practice setting, percentage of consultation caseload consisting of prostate cancer, and nationality were set as effect modifiers. One thousand two hundred fifty-three physicians (846 radiation oncologists and 407 urologists) completed the survey. Radiation oncologists were more likely to recommend adjuvant RT and consider it to be underutilized, and more likely to recommend salvage RT at lower prostate-specific antigen thresholds (P<0.0001). Urologists were more likely to recommend salvage radical prostatectomy or cryoablation for local salvage after RT, whereas radiation oncologists were more likely to recommend RT-based modalities and more likely to report that local salvage was underutilized after RT (P<0.0001). Urologists were more likely to report that upfront radical prostatectomy was a better definitive treatment (P<0.0001), whereas radiation oncologists were more likely to report the opposite (P=0.005). Specialty biases permeate recommendations for upfront management and management in the postoperative and post-RT BCR setting, irrespective of available evidence. These data reveal the critical need for multidisciplinary clinics and cross-specialty training as potential solutions for overcoming specialty bias.

Cancer patient preferences for quality and length of life.

Science.gov (United States)

Meropol, Neal J; Egleston, Brian L; Buzaglo, Joanne S; Benson, Al B; Cegala, Donald J; Diefenbach, Michael A; Fleisher, Linda; Miller, Suzanne M; Sulmasy, Daniel P; Weinfurt, Kevin P

2008-12-15

Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of a life-threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of the current study was to describe cancer patient values regarding QOL and LOL and explore associations with communication preferences. Patients with advanced cancer completed a computer-based survey before the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences, and cancer-related distress. Among 459 patients with advanced cancer, 55% placed equal valued on QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer-related distress (P LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. These data indicate that a values preference for LOL versus QOL may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients.

Evaluation of a cancer exercise program: patient and physician beliefs.

Science.gov (United States)

Peeters, C; Stewart, A; Segal, R; Wouterloot, E; Scott, C G; Aubry, T

2009-08-01

Participation in an exercise intervention during cancer treatment diminishes the side effects associated with cancer therapies, although such benefits vary according to the disease and the patient characteristics. A structured exercise program providing an individualized fitness program tailored to the patients' illness, treatment, and fitness level would address this variability. However, the need, desired components, and anticipated barriers of such a program have not been systematically explored from either the point of view of cancer patients or treating oncologists. Sixty-six cancer patients and 18 medical and radiation oncologists were surveyed on the above variables. Cancer patients and oncologists alike perceived a need for a structured exercise program during and after medical treatment for cancer. Among cancer patients, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the patient's previous exercise and medical history. Over a third of patients reported interest in a hospital-based fitness program. Oncologists were in favor of appropriate supervision of patients during exercise, and noted insufficient time to discuss exercise in their practice. Respondents noted time and parking as barriers to participation. Overall, results support the need for a supervised exercise program during active treatment for cancer and highlight the desired features of such a program.

A stakeholder-driven approach to improve the informed consent process for palliative chemotherapy.

Science.gov (United States)

Enzinger, Andrea C; Wind, Jennifer K; Frank, Elizabeth; McCleary, Nadine J; Porter, Laura; Cushing, Heather; Abbott, Caroline; Cronin, Christine; Enzinger, Peter C; Meropol, Neal J; Schrag, Deborah

2017-08-01

Patients often anticipate cure from palliative chemotherapy. Better resources are needed to convey its risks and benefits. We describe the stakeholder-driven development and acceptability testing of a prototype video and companion booklet supporting informed consent (IC) for a common palliative chemotherapy regimen. Our multidisciplinary team (researchers, advocates, clinicians) employed a multistep process of content development, production, critical evaluation, and iterative revisions. Patient/clinician stakeholders were engaged throughout using stakeholder advisory panels, featuring their voices within the intervention, conducting surveys and qualitative interviews. A national panel of 57 patient advocates, and 25 oncologists from nine US practices critiqued the intervention and rated its clarity, accuracy, balance, tone, and utility. Participants also reported satisfaction with existing chemotherapy IC materials. Few oncologists (5/25, 20%) or advocates (10/22, 45%) were satisfied with existing IC materials. In contrast, most rated our intervention highly, with 89-96% agreeing it would be useful and promote informed decisions. Patient voices were considered a key strength. Every oncologist indicated they would use the intervention regularly. Our intervention was acceptable to advocates and oncologists. A randomized trial is evaluating its impact on the chemotherapy IC process. Stakeholder-driven methods can be valuable for developing patient educational interventions. Copyright © 2017 Elsevier B.V. All rights reserved.

Radiation treatment for cervical esophagus: patterns of practice study in Canada, 1996

International Nuclear Information System (INIS)

Tai, Patricia; Van Dyk, Jake; Yu, Edward; Battista, Jerry; Schmid, Matthew; Stitt, Larry; Tonita, Jon; Coad, Terry

2000-01-01

Purpose: To assess the patterns of practice among Canadian radiation oncologists who treat esophageal cancers, using a trans-Canada survey, completed at the end of 1996. Methods and Materials: One of 3 case presentations of different stages of cervical esophageal cancer was randomly assigned and sent to participating radiation oncologists by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline target volumes for the boost phase of radiotherapy. Radiation oncologists from 26 of 27 (96%) of all Canadian centers participated. Results: High-energy X-rays (no. >=no. 10 MV) were employed by 68% of the respondents in part of the treatment course. The majority (83%) of the radiation oncologists used at least two phases of treatment. Very few, 10 of 59 (17%), responses started with multifield treatment. The most frequently used prescription dose was 60 Gy/30 fractions/6 weeks, given with concurrent chemotherapy. Dose prescriptions were to the isocenter in 39 of 48 (81%) or to a particular isodose line in 9 of 48 (19%) of respondents. Conclusion: There was a variety of radiation treatment techniques in this trans-Canada survey. The majority of the patients had combined cisplatin-based chemoradiation. The isocenter was not used consistently as a dose prescription point

Uusi maalijaid Tartust

Index Scriptorium Estoniae

2007-01-01

Tartu Ülikooli maalikunsti eriala lõpetajate Veiko Klemmeri, Helen Kikkase ja Margit Lõhmuse tööde näitus Tartu Kunstimuuseumis ning Ronald Baumanni, Nadezhda Tshernobai ja Jäppe Johansoni näitus Tartu Kunstimajas

African Journal of Biotechnology - Vol 6, No 10 (2007)

African Journals Online (AJOL)

Anti-inflammatory activity of Ruta graveolens Linn on carrageenan induced paw edema in wistar male rats · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. M Ratheesh, A Helen ...

Õpetajaks õppimas / Mari-Helene Kaber

Index Scriptorium Estoniae

Kaber, Mari-Helene

2008-01-01

Humana People to people liikumise poolt loodud õpetajate koolitamise võrgustikust, mis tegutseb Angolas, Mosambiigis ja Malawis ja kus valmistatakse ette õpetajaid peamiselt maapiirkondade koolidesse

Uue oskuse võlu / Helen Talalaev

Index Scriptorium Estoniae

Talalaev, Helen

2009-01-01

Tutvustatakse kirjastuse TEA väljaantud õppekomplekte: Tomalin, Barry. Westminster English. Tallinn : TEA Kirjastus, 2009 ; Mangus, Inga. Vene keele õpik : algajale ja taasalustajale. Tallinn : TEA Kirjastus, 2008

"ARS 01", perspektiivide avamine / Helen Kivisoo

Index Scriptorium Estoniae

Kivisoo, Helen

2001-01-01

30. IX 2001-20. I 2002 Kiasmas kuuendat korda toimuvast rahvusvahelisest näitusest "ARS", kus Eestist osaleb Marko Mäetamm. Kuraatorid Tuula Arkio, Maaretta Jaukkuri, Patrik Nyberg, Jari-Pekka Vanhala. Teemaks "kolmas ruum". Näituse kajastamisest.

Risk management of radiation therapy. Survey by north Japan radiation therapy oncology group

International Nuclear Information System (INIS)

Aoki, Masahiko; Abe, Yoshinao; Yamada, Shogo; Hareyama, Masato; Nakamura, Ryuji; Sugita, Tadashi; Miyano, Takashi

2004-01-01

A North Japan Radiation Oncology Group (NJRTOG) survey was carried out to disclose the risk management of radiation therapy. During April 2002, we sent questionnaires to radiation therapy facilities in northern Japan. There were 31 replies from 27 facilities. Many incidents and accidents were reported, including old cases. Although 60% of facilities had a risk management manual and/or risk manager, only 20% had risk management manuals for radiation therapy. Eighty five percent of radiation oncologists thought that incidents may be due to a lack of manpower. Ninety percent of radiation oncologists want to know the type of cases happened in other facilities. The risk management system is still insufficient for radiation therapy. We hope that our data will be a great help to develop risk management strategies for radiation therapy for all radiation oncologists in Japan. (author)

Practical consensus recommendations on management of triple-negative metastatic breast cancer

Directory of Open Access Journals (Sweden)

R Rangarao

2018-01-01

Full Text Available Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR- and human epidermal growth factor receptor 2 (HER2-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.