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Enewetak Atoll underwent 43 historical nuclear tests from 1948 to 1958, including the first hydrogen bomb test, resulting in a substantial nuclear material fallout contaminating the Atoll and the lagoon waters. The radionuclide fallout material deposited in lagoon sediments and soil on the islands will remain for decades to come. With intensifying climate and extreme weather events, the possibility of redistribution of deposited radionuclide material has become a great concern. This study uses a numerical modeling approach to estimate the potential elevated radionuclide concentrations that can be distributed during storm events under current and future climates. We simulated three historical storm scenarios that are most likely to impact Atoll’s environment and remobilize the radionuclide-bound sediments. WRF-ARW was used to reconstruct these storm scenarios under current year (2015) and future year (2090) climates. Storm-induced ocean hydrodynamics conditions were generated using FVCOM. FVCOM-ICM was externally coupled to simulate the fate and transport of radionuclides. Given that the 239Pu is the largest fraction of the radionuclide inventory of the lagoon and Atoll islands, the model results show the highest average incremental 239Pu concentration that an island may be exposed to is 3.25E-4 Bq/m3 (becquerel per cubic meters), which is an increase of 84 times the average baseline/existing 239Pu concentration without the storm conditions. The overall increase in 239Pu average over all the islands of Atoll is about 20 folds relative to the baseline concentration. Despite the high relative increase ratios, a comprehensive exposure assessment is required to investigate the exposure risk. Further, due to the limitations of the study and uncertainties/biases in the historical data used, further research supported by field surveys to better characterize the current contamination level may be needed to make more accurate predictions. [ABSTRACT FROM AUTHOR]

Purpose: Cervical cancer is a significant global health burden, with advancements in treatment modalities improving outcomes. However, vaginal toxicities following definitive chemoradiation remain a concern, impacting patients' quality of life. The aim of this systematic review and meta-analysis was to estimate the incidence of vaginal toxicities, explore associated factors, and assess the relationship with radiation dose in intact cervical cancer patients undergoing radical chemoradiation. Material and methods: A systematic search of PubMed, Google Scholar, and Cochrane databases was conducted. Studies reporting on vaginal toxicities post-radical chemoradiation in intact cervical cancer patients were included. Data extraction and analysis were performed according to PRISMA guidelines. Results: Twenty-four studies with various designs were included. The meta-analysis revealed a pooled estimate of 39% (95% CI: 21-56%) for overall vaginal toxicities among cervical cancer patients following definitive chemoradiation. Vaginal stenosis was the most commonly reported toxicity, with a median incidence of 61.5% (range, 20-77.8%) across the studies. Severe toxicities (grade = 3) were reported at rates of 12.74% (CTCAE v. 4.0), 0.98% (CTCAE v. 3.0), 10.41% (RTOG/EORTC), and 0% (LENT-SOMA). Factors, such as age, initial vaginal involvement, and radiation dose were associated with increased toxicity risk. Significant heterogeneity was observed in study populations and methodologies. Conclusions: Vaginal toxicities are common following definitive chemoradiation in intact cervical cancer patients, with vaginal stenosis being predominant. Standardization of toxicity scoring methods and radiotherapy dose reporting parameters is crucial for accurate comparison and interpretation of findings. Future research should focus on optimizing treatment strategies to minimize vaginal toxicities while maximizing efficacy and patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This survey aimed to understand the practice pattern and attitude of Indian doctors towards prostate brachytherapy. Material and methods: A 21-point questionnaire was designed in Google form and sent to radiation oncologists practicing in India, using texts, mails, and social media. Responses were collated, and descriptive statistical analysis was performed. Results: A total of 212 radiation oncologists from 136 centers responded to the survey questionnaire, with majority (66%) being post-specialty training > 6 years. We found that about 44.3% (n = 94) of respondents do not practice interstitial brachytherapy for any site, and majority (83.3%, n = 175) do not practice high-dose-rate (HDR) prostate brachytherapy. Only 2.8% (n = 6) of doctors preferred boost by brachytherapy compared with 38.1% (n = 80) of respondents, who favored stereotactic body radiation therapy (SBRT) boost. When asked about the indication of HDR prostate brachytherapy in Indian setting, 32.5% (n = 67) of respondents favored monotherapy, 46.1% (n = 95) of oncologists thought boost as a good indication, and 21.4% (n = 44) preferred re-irradiation/salvage setting. The most cited reason for prostate brachytherapy not being popularly practiced in India was lack of training (84.8%, n = 179). It was also noted that out of 80 respondents who practiced SBRT for prostate boost, 37 would prefer HDR brachytherapy boost if given adequate training and facilities. Conclusions: The present survey provided insight on practice of prostate brachytherapy in India. It is evident that majority of radiation oncologists do not practice HDR prostate brachytherapy due to lack of training and infrastructure. Indian physicians are willing to learn and start prostate brachytherapy procedures if dedicated training and workshops are organized. [ABSTRACT FROM AUTHOR]

Little is known about leisure consumption among professional women in emerging economies like India in contrast to extensive research on this topic in the West. This group of professional women, however, is of growing economic and social clout within their countries with increasingly important ramifications for the choices they take, including leisure. This study aims to understand meanings and expressions of leisure among urban Indian middle-class working women. Using a phenomenological approach, 28 urban Indian middle-class women working in Bangalore from varied sectors, belonging to different age groups and at diverse life-stages, were interviewed in-depth between the period of July 2017 and September 2018. The analysis showed that leisure activities among urban Indian middle-class working women strike a delicate balance between individual and social fulfilment. The activities were varied and performed for passion, health and well-being, commitment and fun. Two new meanings of leisure emerged from the study: being with myself and being stress-free. It was seen that this group of working women are actively negotiating a new balance – the work–leisure balance – between demands of their work-life and their own need for personal leisure. These new meanings, reflective of newly empowered gender roles in the changing socio-economic environment of emerging economies, saliently extend our understanding of gendered meaning of leisure. [ABSTRACT FROM AUTHOR]

Management of forest lands under climate warming poses challenges to managers, some of which are difficult to predict. Examining the trade‐offs associated with forest stewardship choices is essential to avoid consequences associated with loss of natural capital. We utilized LANDIS‐II process model simulations for three forested sites located in disparate parts of the United States with the purpose of understanding the trade‐offs imposed by management choices under climate warming and associated wildfire. There were only small trade‐offs that emerged from the simulations, between habitat area for threatened and endangered species (TES), net ecosystem exchange for CO2 (NEE), and risk of wildfire. Stand management in the form of thinning and prescribed burning typically increased NEE while simultaneously increasing habitat for TES, while reducing the risk of wildfire. These benefits were also observed under a climate warming scenario; however, the benefits were greatly outweighed by the negative impacts of warming on both TES habitat and NEE. Balancing these ecosystem services via thinning and burning treatments is a strategic approach to mitigate risks of wildfire both currently and under a warming future climate. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify the leadership characteristics that make a health-care organization ready for lean implementation, analyse the interdependence among them and determine the rank of each characteristic based on their influence in the overall phenomenon. Design/methodology/approach: The leadership characteristics were identified through a review followed by an expert interview. Then, total interpretive structural modelling (TISM) was used to analyse the interdependence and determine the rank, driving power and dependence of each characteristic. Findings: The results suggest that modesty is the most crucial leadership characteristic that makes a health-care organization ready for the successful incorporation of lean practices. Apart from that, attributes such as transparency, accountability, a leader's ability to empower the employees and communication play a significant role in making the change management programme impactful and effective. A leader's team building capacity was found to be the dependent characteristic and was ranked the last in the overall phenomenon. Research limitations/implications: Though this study throws light on various leadership dispositions that prepare a health-care organization to become a lean, it is still not an exhaustive exploration to be generalized. Because the leadership characteristics required for successful lean implementation may vary from one organization to the other depending on the purpose, intensity and priority of the implementation programme, these parameters along with the complexity of the scenario would determine what other leadership characteristics need to be included in the model to make it more robust and holistic. Originality/value: The novelty of the study lies in capturing the leadership characteristics for organizational readiness in the health-care sector and using the TISM approach to identify the critical characteristics in the context of lean implementation in hospitals. [ABSTRACT FROM AUTHOR]

Background: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting.Methods: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching.Results: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available.Conclusions: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted. [ABSTRACT FROM AUTHOR]

Leadership plays a significant role in shaping an organization's culture. A new type of organization is emerging that aims at not only earning profit through its business, but also at contributing to the benefit and well being of the members of the society. These organizations are led by a new type of leader who is called a humanistic leader (Prasad, 2011). This paper looks at the importance of humanistic leadership style in shaping this new type of organization. We also look at these organizations using the lens of established frameworks such as the Corporate Social Responsibility pyramid developed by Buchholtz& Carroll. These organizations look at the well-being of all stakeholders including owners, vendors, customers, employees and other shareholders. These organizations behave like responsible corporate citizens and new emerging research suggests that these organizations are being rewarded by their customers, as well as the shareholders. This development will in turn create a new model of business which is based on win-win strategy for all the stakeholders of an organization. Many of these new class of leaders display higher order needs such as self-transcendence and self-actualization in the Maslow's schema of needs arranged in a hierarchical pyramid. This paper suggests that the research in the areas of individual motivation of leaders can be merged with research in the area of leadership and organizational culture to help understand this new emerging trend. [ABSTRACT FROM AUTHOR]

Background: During revision hip replacement surgery, the cementless acetabular shell is often well fixed but the locking mechanism may be ineffective. Cementing a new liner into the existing acetabular shell (the double-socket technique) can provide a simple solution. The purposes of the present study were to review our initial clinical results and to define the potential limitations of this technique.Methods: Thirty-two hips with a preexisting well-fixed acetabular socket that had been in situ for an average of 8.6 years were treated with the insertion of a new polyethylene liner (seventeen hips) or a metal liner (fifteen hips) with use of cement. The indication for this technique was a deficient locking mechanism in twenty-two hips and the unavailability of a matching liner in ten hips. Anteroposterior radiographs of all hips were analyzed by a single independent reviewer.Results: The mean duration of follow-up was 5.1 years. Six hips required a reoperation after a mean of 29.7 months; the reasons for the reoperations included aseptic failure of the acetabular construct (four hips), instability (one hip), and sepsis (one hip). The University of California at Los Angeles hip scores improved significantly (p < 0.001) compared with the preoperative values; specifically, the mean score improved from 6.2 to 9.1 for pain, from 6.3 to 8.3 for walking, from 6.2 to 7.8 for function, and from 4.7 to 5.8 for activity. The prevalence of dislocation was 22%. Kaplan-Meier analysis with revision as the end point revealed a five-year survival rate of 78% (95% confidence interval, 55% to 91%).Conclusions: The double-socket technique is a good alternative to acetabular socket removal for suitable candidates who have a well-fixed cementless socket with an inner diameter that is larger than the outer diameter of the cemented liner. This technique preserves acetabular bone stock and permits conversion to alternate bearing surfaces. We believe, however, that removal of a well-fixed acetabular shell or the use of a constrained liner should be strongly considered for patients with a history of hip instability. [ABSTRACT FROM AUTHOR]

In this paper a physically based snow transport model (SnowTran-3D) was used to simulate snow drifting over a 30 m grid and was compared to detailed snow water equivalence (SWE) surveys on three dates within a small 0.25 km2 subwatershed, Upper Sheep Creek. Two precipitation scenarios and two vegetation scenarios were used to carry out four snow transport model runs in order to (1) evaluate the blowing snow model, (2) evaluate the sensitivity of the snow transport model to precipitation and vegetation inputs, and (3) evaluate the linearity of snow accumulation patterns and the utility of the drift factor concept in distributed snow modeling. Spatial comparison methods consisted of (1) pointwise comparisons of measured and modeled SWE, (2) visual comparisons of the spatial maps, (3) comparisons of the basin-wide average SWE, (4) comparisons of zonal average SWE in accumulation and scour zones, and (5) comparisons of distribution functions. We found that the basin average modeled SWE was in reasonable agreement with observations and that visually the spatial pattern of snow accumulation was well represented except for a pattern shift. Pointwise comparisons between the modeled and observed SWE maps displayed significant errors. The distribution functions of SnowTran-3D-modeled drift factors from two precipitation scenarios on three dates were compared with the distribution function of observation-based drift factors obtained previously by calibration to evaluate the assumption of linearity. We found only a 14% reduction in explained variance in the distribution function of drift factors for a 69% increase in precipitation, suggesting that the simplification provided by the use of drift factor distributions will result in errors that are tolerable in many cases. [ABSTRACT FROM AUTHOR]

Indira Gandhi Institute of Medical Sciences, Regional Cancer Center was established in 1993. It's one of the main Health-Care Institution in the state of Bihar. The data of 205 patients was presented in the ICON meeting and 98% of patients were diagnosed in chronic phase. Complete hematological response was seen in 91% of patients in 3 months. A total of 197 (96%) patients were alive at the time of analysis of which 179 (87%) were still in chronic phase with hematological remission. [ABSTRACT FROM AUTHOR]

Discusses the case of a 50-year-old male patient presenting wth leptomeningeal carcinomatosis from carcinoma of the palatine tonsil. Development of the condition following radical radiotherapy; Disease background.