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This guideline provides evidence-based recommendations on appropriate indications and techniques for partial breast irradiation (PBI) for patients with early-stage invasive breast cancer and ductal carcinoma in situ. ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose-fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. PBI delivered using 3-dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose-fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens due to late toxicity concerns. Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI. [ABSTRACT FROM AUTHOR]

While historically reserved for patients with locally advanced breast cancer, the indications for preoperative systemic therapy have expanded in parallel with our increased understanding of breast cancer biology. Patient selection for preoperative chemotherapy is now primarily driven by breast cancer subtype and the incorporation of targeted therapies in HER2+ disease as well as immunotherapy in triple negative breast cancer have resulted in increasing response rates and more tailored treatment approaches. Potential benefits with respect to local therapy, now include both tumor downstaging to facilitate breast conservation as well as de-escalation of both axillary surgery and/or nodal radiation for patients who experience a pathologic complete response. Implementing these strategies requires a multidisciplinary approach and best practices for managing the breast and axilla after preoperative chemotherapy continue to evolve. Here we review the current landscape and future directions for local therapy considerations after preoperative chemotherapy. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Preoperative systemic therapy (PST) followed by mastectomy and radiation improves survival for patients with inflammatory breast cancer (IBC). Residual disease within the skin post-PST adversely impacts surgical outcome and risk of local-regional recurrence (LRR). We aimed to assess magnetic resonance imaging (MRI) breast skin changes post-PST with pathologic response and its impact on surgical resectability.Materials and Methods: We retrospectively reviewed 152 baseline and post-PST breast MRIs of 76 patients with IBC. Using the ACR-BIRADS MRI lexicon, we correlated skin thickness, qualitative enhancement, and kinetic analysis with pathologic response in the skin at mastectomy.Results: Baseline MRI showed skin thickening in all 76 patients, 75/76 (99%) showed skin enhancement, 54/75 (72%) had medium/fast initial kinetics, usually with persistent delayed kinetics in 49/54 (91%). Following PST, 66/76 (87%) had residual skin thickening with 64/76 (84%) showing a decrease; 33/76 (43%) had persistent enhancement. The median thickness post-PST was 4.7 mm with residual tumor in the skin, and 3.0 mm without residual tumor (p = 0.008). Regardless of pathologic response, the majority of patients had persistent skin thickening on MRI following PST (100% [14/14] with residual tumor and 84% [52/62] without residual tumor). There was no association between post-PST skin thickness on breast MRI and rate of LRR.Conclusion: Patients with IBC have skin thickening and enhancement on baseline breast MRI, with a statistically significant reduction in skin thickness following successful PST. Despite persistent skin changes on MRI, patients achieving a partial or complete parenchymal response to PST may proceed to mastectomy with low LRR rates. [ABSTRACT FROM AUTHOR]

Conservation of maize landraces in the Mexico center of origin is critical for sustainable agriculture. However, farmers in many regions of Mexico are reducing landraces for more modern maize varieties, particularly hybrid maize. The reasons why farmers choose to maintain maize landraces have been recently recognized to be strongly linked to their specific values (i.e., intrinsic, instrumental, and relational values). However, there is a lack of studies that empirically investigate the nuances of farmers' specific values and how these values are adequately considered in broad agricultural policies. Using a mixed-methods case study based in indigenous and mestizo communities in Chiapas, Mexico, we analyzed farmers' maize production strategies, how those strategies connect to farmers' value orientations, and the limitations that they confront in enacting such values. We found that households within both indigenous and mestizo communities fell into one of three categories regarding their maize production: 1) hybrid maize production for market sales, 2) landrace production for household consumption, and 3) a combination of these two strategies. All farmers hold a diversity of values in which mostly instrumental and relational values were mentioned among the three groups of farmers, who emphasized the livelihood and subsistence value of maize. Value differences for farmers who prioritize the cultivation of maize landraces were related to the strength of relational values, such as the biocultural diversity and heritage value of maize. In contrast, the farmers relying on hybrid varieties were the ones confronting the most limitations to their maize production, particularly economic limitations. Based on our empirical findings, we conclude that policies aimed at promoting the conservation of landraces must extend beyond a purely economic and market-oriented approach. The current policy emphasis on instrumental values is likely to fall short in achieving the desired outcomes since it does not sufficiently foster plural values that underpin the continued production of maize landraces. • Farmers managing maize landraces hold a diversity of values associated with their livelihoods and subsistence. • Maize landraces mostly operate outside of global market logic buffering farmers' risks with climate, labor and capital. • Farmers managing hybrid maize confront several limitations due to rising input prices and low prices of their maize sales. • Current agricultural policies do not adequately integrate diverse values, affecting maize landrace conservation. [ABSTRACT FROM AUTHOR]

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To quantify gait abnormalities in people with Dravet syndrome (DS). Individuals with a confirmed diagnosis of DS were enrolled, and stratified according to knee flexion at initial contact (IC) and range of motion (ROM) during stance (atypical crouch: knee flexion >20° at IC and knee ROM >15° during stance; straight: knee flexion <20° at IC). A 1D ANOVA (α = 0.05) was used to test statistical differences among the joint kinematics and spatio–temporal parameters of the cohort and an age-matched control group. Clinical (neurological and orthopaedic evaluation) and anamnestic data (seizure type, drugs, genetic mutation) were collected; distribution between the two gait phenotypes was assessed with the Fisher exact test and, for mutation, with the chi-squared test (p < 0.05). Linear regression between maximum knee flexion and normalised walking speed was calculated. Seventy-one subjects were enrolled and evaluated with instrumented gait analysis. Fifty-two were included in final analysis (mean age 13.8 ± 7.3; M 26). Two gait patterns were detected: an atypical crouch gait (34.6%) with increased ankle, knee and hip flexion during stance, and reduced walking speed and stride length not associated with muscle-tendon retractions; and a pattern resembling those of healthy age-matched controls, but still showing reduced walking speed and stride length. No differences in clinical or anamnestic data emerged between the two groups. Objectively quantified gait in DS shows two gait patterns with no clear-cut relation to clinical data. Kinematics abnormalities may be related to stabilization issues. These findings may guide rehabilitative and preventive measures. • Dravet syndrome presents a clear-cut gait abnormality, "atypical crouch gait" (AC). • AC does not present major muscular-skeletal abnormalities as typical crouch gait. • No correlation with genetic mutation, seizure types, and antiepileptic treatment. [ABSTRACT FROM AUTHOR]

Postmastectomy radiation therapy (PMRT) delivered to an immediate reconstruction increases the risk of surgical complications. Although acellular dermal matrix (ADM) has been used with immediate tissue expander (TE) reconstruction to improve cosmetic outcomes and minimize capsular contracture, there is a paucity of data on this approach in the setting of PMRT. Thirty-two patients with stage I to III breast cancer were treated with mastectomy, immediate TE-ADM reconstruction, and PMRT between 2009 and 2012 in a prospective single-arm study. The primary objective was the "success" rate, determined by the number of patients at 2 years after PMRT having an intact final reconstruction, no major complications, and a cosmetic outcome rated by a physician as excellent or good. The median follow-up was 24 months. Final reconstruction status was known in 31 of 32 patients (96.9%; 1 patient left the country) and completed in 29 of 31 patients (93.5%; implant, n = 26; flap, n = 1; both, n = 2; none, n = 2). At 2 years, 6 patients were unevaluable (metastatic disease, n = 3; withdrawn consent, n = 1; left the country, n = 2). Of 26 evaluable patients, the success rate was 65.4% (17 of 26). Lack of success was the result of "fair" cosmesis (n = 2), infection (n = 2), severe capsular contracture (n = 1), major revision (n = 2), and no final reconstruction (n = 2). Most patients had good-to-excellent 2-year overall cosmesis based on patient perception (15; 62.5%) and physician evaluation (19; 79.2%). To the best of our knowledge, this is the first dedicated prospective trial evaluating long-term cosmetic and complication outcomes in patients treated with immediate TE-ADM reconstruction followed by PMRT. Most patients (65.4%) met the success criteria in this prospective single-arm series. The great majority (93.5%) achieved final reconstruction; most had good-to-excellent overall cosmetic outcomes (79.2%). The results with longer follow-up will be of interest, and further investigation of strategies to optimize reconstruction with PMRT are warranted. [ABSTRACT FROM AUTHOR]

Chronic pancreatitis remains a challenging inflammatory disease, causing progressive, irreversible fibrosis of the pancreatic parenchyma. Several surgical options for treatment have been established, but duodenum-preserving pancreatic head resections seem to be the most favorable option other than pancreatoduodenectomy. The aim of this retrospective analysis is to evaluate the outcomes of the Hamburg modification of duodenum-preserving pancreatic head resections. We retrospectively evaluated—for long-term outcomes concerning pain control, quality of life, and symptom control—500 consecutive patients suffering from painful chronic pancreatitis who had undergone the Hamburg modification of the duodenum-preserving pancreatic head resection. Additionally, the patients were compared with a database of 104 patients who underwent duodenum-preserving pancreatic head resections according to Beger or Frey. After a mean follow-up of 10 years, overall survival was 90% in those patients having undergone the Hamburg modification. Regarding analgetic medications, the median pain score for frequency of pain attacks, measured by a visual analog scale and inability to work, was 0 (0–100), and the global quality of life revealed a median of 92 (0–100). In addition, we found that a high rate of patients continued consuming alcohol after the operation (37.9%). The rate of redo surgery owing to the recurrence of chronic pancreatitis was 7.6% after this Hamburg modification. Duodenum-preserving pancreatic head resections provide adequate outcomes in terms of pain control, quality of life, and symptom control. In this retrospective analysis, the Hamburg modification was found to be a good alternative to other forms of duodenum-preserving pancreatic head resections. The choice of a certain modification of the duodenum-preserving pancreatic head resection may depend on the surgeon's expertise and the individual needs of the patient. [ABSTRACT FROM AUTHOR]

Background The aim of this prospective multicenter study was to evaluate clinical and radiologic results of a new metaphyseal anchored system. This system features a different anchor geometry that potentially leads to better bony integration and less loosening. Methods From November 2012 until December 2015, 148 patients (151 shoulders) were treated with the Sidus Stem-Free Shoulder System at 9 centers in Europe. The main indication was primary osteoarthritis (80.1%). This analysis only includes patients diagnosed with primary osteoarthritis (n = 121). A clinical evaluation was performed using the Constant-Murley score, Subjective Shoulder Value, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, and range of motion. Radiologic assessment was based on the occurrence of radiolucent lines and signs of implant migration, osteolysis, loosening, and heterotopic ossification. Results We evaluated 105 patients after a follow-up period of 2 years. There were 53 women and 52 men. The average age was 64 years. Total shoulder arthroplasty was performed in 73 cases and hemiarthroplasty in 32. The Constant-Murley score improved from 26 points preoperatively to 70 points at 2 years' follow-up ( P  < .001). The Subjective Shoulder Value increased from 34% to 84% ( P  < .001), and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form increased from 34 points to 86 points ( P  < .001). Radiologically, neither migration nor loosening was found. However, radiolucent lines of 2 mm or greater could be detected around the glenoid in 2 cases, but none of them have had clinical relevance yet. The overall complication rate was 6.7%, and the revision rate was 0%. Conclusion Patients with the Sidus Stem-Free Shoulder System achieve good clinical and radiologic short-term results that are comparable with the results of other stem-free shoulder implants. [ABSTRACT FROM AUTHOR]

Introduction The purpose of this guideline is to offer recommendations on fractionation for whole breast irradiation (WBI) with or without a tumor bed boost and guidance on treatment planning and delivery. Methods and materials The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions focused on dose-fractionation for WBI, indications and dose-fractionation for tumor bed boost, and treatment planning techniques for WBI and tumor bed boost. Guideline recommendations were based on a systematic literature review and created using a predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. Results For women with invasive breast cancer receiving WBI with or without inclusion of the low axilla, the preferred dose-fractionation scheme is hypofractionated WBI to a dose of 4000 cGy in 15 fractions or 4250 cGy in 16 fractions. The guideline discusses factors that might or should affect fractionation decisions. Use of boost should be based on shared decision-making that considers patient, tumor, and treatment factors, and the task force delineates specific subgroups in which it recommends or suggests use or omission of boost, along with dose recommendations. When planning, the volume of breast tissue receiving >105% of the prescription dose should be minimized and the tumor bed contoured with a goal of coverage with at least 95% of the prescription dose. Dose to the heart, contralateral breast, lung, and other normal tissues should be minimized. Conclusions WBI represents a significant portion of radiation oncology practice, and these recommendations are intended to offer the groundwork for defining evidence-based practice for this common and important modality. This guideline also seeks to promote appropriately individualized, shared decision-making regarding WBI between physicians and patients. [ABSTRACT FROM AUTHOR]

Purpose Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases. Methods From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulmonary resection of which 83 for CPAM (lobectomy, wedge resection or sequestrectomy). We retrospectively reviewed the characteristics of surgical procedure, postoperative management and complications through three time periods (September 2007–December 2009: n = 14, January 2010–March 2013: n = 30, April 2013–May 2016: n = 39) corresponding to management protocols modifications introducing fast-track pathways. Results Through the 3 time periods, median postoperative hospital stay decreases (4, 3, 2 days successively, P = 0.02). In the third time period, 4 patients underwent surgery in day-case surgery. The overall and surgical complication rates, mainly related to air leakage, remain stable through the 3 time periods (14%, P = 0.41 and 10%, P = 0.52 respectively). Among the 13 patients without postoperative pleural drainage, one required secondary drainage after a partial resection of an emphysema. Conclusion Fast-track protocol for children undergoing uncomplicated thoracic surgery for CPAM seems feasible without extra morbidity. Selected patient undergoing thoracoscopic resection of the lung may benefit from the absence of pleural drainage and can be operated on in day-case surgery. Level of evidence Level III. [ABSTRACT FROM AUTHOR]

Purpose: Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014.Methods: De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System.Results: The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295).Conclusions: Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality. [ABSTRACT FROM AUTHOR]

Patients with cystic fibrosis have increased oxidative stress and impaired antioxidant systems. Moderate intake of docosahexaenoic acid (DHA) may favor the lowering of oxidative stress. In this randomized, double-blind, cross-over study, DHA or placebo capsules, were given daily to 10 patients, 5 mg/kg for 2 weeks then 10 mg/kg DHA for the next 2 weeks (or placebo). After 9 weeks of wash-out, patients took placebo or DHA capsules. Biomarkers of lipid peroxidation and vitamin E were measured at baseline, and after 2 and 4 weeks of treatment in each phase. The proportions of DHA increased both in plasma and platelet lipids after DHA supplementations. The lipid peroxidation markers did not significantly decrease, in spite of a trend, after the first and/or the second dose of DHA but plasma and platelet vitamin E amounts increased significantly after DHA supplementation. Our findings reinforce the antioxidant potential of moderate DHA intake in subjects displaying increased oxidative stress. [ABSTRACT FROM AUTHOR]

The management of regional nodes in early-stage invasive breast cancer continues to evolve. Improved systemic therapy has contributed to better local regional control, and at the same time it has drawn more attention to its importance. Axillary dissections have decreased, in part because of the increased efficacy of systemic therapy, and also because adjuvant therapy decisions are increasingly driven by biologic characterization of the tumor rather than pathologic nodal information. The trend toward less axillary surgery and a shift toward increased reliance on systemic and radiation therapy to address nodal disease has created interesting questions that were subsequently addressed in recent trials. We review the controversies in regional nodal management, the benefits of current treatment paradigms, the balance between less surgery and more radiation, and the potential tradeoffs vs toxicity. [ABSTRACT FROM AUTHOR]

Purpose Deep inspiration breath hold (DIBH) is used to decrease cardiac irradiation during radiation therapy (RT) for breast cancer. The patients most likely to benefit and the impact on treatment time remain largely unknown. We sought to identify predictors for the use of DIBH and to quantify differences in dosimetry and treatment time using a prospective registry. Methods and materials A total of 150 patients with left breast cancer were enrolled. All patients were simulated with both free breathing (FB) and DIBH. RT was delivered by either modality. Alternate scans were planned with use of deformable registration to include identical RT volumes. DIBH patients were monitored by a real-time surface tracking system, AlignRT (Vision RT, Ltd, London, United Kingdom). Baseline characteristics and treatment times were compared by Fisher exact test and Wilcoxon rank sum test. Dosimetric endpoints were analyzed by Wilcoxon signed rank test, and linear regression identified predictors for change in mean heart dose (∆MHD). Results We treated 38 patients with FB and 110 with DIBH. FB patients were older, more likely to have heart and lung disease, and less likely to receive chemotherapy or immediate reconstruction (all P < .05). Treatment times were not significantly different, but DIBH patients had greater variability in times ( P = .0002). Of 146 evaluable patients, DIBH resulted in > 20 cGy improvement in MHD in 107 patients but a > 20 cGy increase in MHD in 14. Both MHD and lung V20 were significantly lower in DIBH than in paired FB plans. On multivariate analysis, younger age (4.18 cGy per year; P < .0001), higher body mass index (6.06 cGy/kg/m 2 ; P = .0018), and greater change in lung volumes (130 cGy/L; P = .003) were associated with greater ∆MHD. Conclusions DIBH improves cardiac dosimetry without significantly impacting treatment time in most patients. Greater inspiratory lung volumes augment this benefit. Because the improvement with DIBH was not uniform, patients should be scanned with both FB and DIBH. [ABSTRACT FROM AUTHOR]

Purpose This study explores the experiences and needs of bereaved family and friends following an epilepsy-related death in Australia. Method An online survey was used to collect demographic details of the person with epilepsy, epilepsy status, time since the death, satisfaction with service providers at the time of death, follow-up support, perceptions on how well the death was explained, and gaps in support or services. Results The survey was completed by 101 respondents describing 90 deceased individuals. Mean age at death was 32.1 years, with causes of death including SUDEP, epilepsy, drowning, cardiac arrest, asphyxiation, and motor vehicle accidents. Over half of the respondents indicated that they did not know, prior to the death, people could die of epilepsy. In addition, 38% indicated the death had not been adequately explained to them. Comments revealed services and supports which should be available following a death, and recommendations for existing epilepsy support services which might help to prevent future deaths. Conclusion Findings highlight the need to improve community understanding and support for those affected by epilepsy and to promote informed risk assessment and communication amongst patients, families and health professionals. People bereaved by epilepsy require both immediate and long-term epilepsy-specific information and support from professionals, informal communities and peer supporters. [ABSTRACT FROM AUTHOR]

Preclinical studies often require animal models for in vivo experiments. Particularly in dental research, pig species are extensively used due to their anatomical similarity to humans. However, there is a considerable knowledge gap on the multiscale morphological and mechanical properties of the miniature pigs' jawbones, which is crucial for implant studies and a direct comparison to human tissue. In the present work, we demonstrate a multimodal framework to assess the jawbone quantity and quality for a minipig animal model that could be further extended to humans. Three minipig genotypes, commonly used in dental research, were examined: Yucatan, Göttingen, and Sinclair. Three animals per genotype were tested. Cortical bone samples were extracted from the premolar region of the mandible, opposite to the teeth growth. Global morphological, compositional, and mechanical properties were assessed using micro-computed tomography (micro-CT) together with Raman spectroscopy and nanoindentation measurements, averaged over the sample area. Local mineral-mechanical relationships were investigated with the site-matched Raman spectroscopy and micropillar compression tests. For this, a novel femtosecond laser ablation protocol was developed, allowing high-throughput micropillar fabrication and testing without exposure to high vacuum. At the global averaged sample level, bone relative mineralization demonstrated a significant difference between the genotypes, which was not observed from the complementary micro-CT measurements. Moreover, bone hardness measured by nanoindentation showed a positive trend with the relative mineralization. For all genotypes, significant differences between the relative mineralization and elastic properties were more pronounced within the osteonal regions of cortical bone. Site-matched micropillar compression and Raman spectroscopy highlighted the differences between the genotypes' yield stress and mineral to matrix ratios. The methods used at the global level (averaged over sample area) could be potentially correlated to the medical tools used to assess jawbone toughness and morphology in clinics. On the other hand, the local analysis methods can be applied to quantify compressive bone mechanical properties and their relationship to bone mineralization. [Display omitted] • A multimodal framework for bone characterization was developed in an animal model that could be further extended to humans. • Jawbone mineralization, morphology, and mechanical properties were assessed in Yucatan, Göttingen and Sinclair minipigs. • A novel femtosecond laser ablation protocol was established for bone micropillar fabrication. • Site-matched micropillar compression and Raman spectroscopy revealed bone microscale structure-properties relationship. [ABSTRACT FROM AUTHOR]

To identify the job expectations and intolerance to uncertainty in final-year nursing students from three Spanish universities and evaluate the differences between them. Multicentre, mixed-methods study. We included nursing students from three universities in Spain (Lleida, A Coruña and Murcia). Questionnaires were used to collect data on sociodemographic variables, job expectations and intolerance to uncertainty. In addition, in-depth personal interviews were conducted to complement quantitative data. Descriptive statistics were calculated and comparison tests (ANOVA, chi-square) were performed to analyse the differences between universities and a content analysis was carried out for qualitative data. The sample included 305 final-year nursing students enrolled in the 2017–2018 and 2018–2019 courses, of which 21 participants were interviewed for the qualitative phase. Findings were reported based on four main themes: Expected employment conditions, perceptions of working conditions, job uncertainty and increased chances of getting a job by continuing education after finishing the nursing degree. Results showed that 92.13% of the students were concerned about their future employment. Analysis of the in-depth interviews highlighted the uncertainty of finding a job as a nurse and the anticipated precarious employment conditions (i.e. lack of stability stemming from daily or weekly temporary contracts) in case they managed to find work. Moreover, it was shown that these perceptions affect their health, leading to situations of anxiety, stress and negativity during their time as nursing students. Overall, 65.57% considered migrating outside their town/region to increase their job opportunities and 97.0% wanted to continue their education after finishing their degree, motivated by their vocation, professional aspirations and to increase their possibilities of finding work. Nursing students find themselves in a situation of great uncertainty before finishing their studies, anticipating a future with great stress and even frustration as a result of unemployment and job insecurity. They even consider the possibility of migrating when they finish their degree to increase their job opportunities. Therefore, it is necessary to improve the recruitment process of nurses in Spain through increased security and stability and thus contribute to reducing the stress and frustration of future nurses. [ABSTRACT FROM AUTHOR]

Abstract: The Moroccan Sahara includes the Dhlou and Adrar Souttouf Massifs, both of which belong to the Souttoufide belt and are located on the western margin of the Archean Reguibat Shield. The Adrar Souttouf Massif has previously been assumed to be part of the Variscan Mauritanian–Appalachian system. New zircon ages from the two units of the Adrar Souttouf Massif have nevertheless allowed us to hypothesise a complex polyphased history. The Massif comprises four NNE–SSW trending units (listed here from east to west). The Sebkha Matallah unit represents the eastern margin of the Adrar Souttouf Massif and is thrust over the Ordovician to Devonian sedimentary Dhloat Ensour Group to the east. A central (Dayet Lawda) unit consisting of mafic and ultramafic rocks is interpreted as a possible remnant of Neoproterozoic oceanic crust or mafic terranes. The western Sebkha Gezmayet and Oued Togba units are mainly composed of granitoids and orthogneisses. Tonian–Stenian (1400–1000Ma) zircon ages recorded in the Oued Togba and Sebkha Gezmayet units suggest an Avalonian–Meguman-like relationship. The other three age groups obtained in these two units are 610 to 570Ma (Pan-African), 530 to 490Ma (Cambrian) and 440 to 270Ma. The latter population cannot result from Variscan orogeny alone, and is possibly linked to the Salinic and Acadian orogenies of Laurentia. Zircon ages of ~3000Ma and ~2650Ma determined for two granite samples from the Archean foreland corroborate data already published. Lower intercept ages of between 226Ma (Upper Triassic) and 158Ma (Upper Jurassic) identified for discordia lines are interpreted as a Mesozoic thermal overprint of the area attributed to the break-up of Pangaea and the initial rifting of the Atlantic Ocean. The ages obtained support a new tectonic model describing the formation of the units of the Adrar Souttouf Massif. [Copyright &y& Elsevier]

Abstract: The application of bioactive meshes in abdominal surgery for the repair of hernias is an increasing clinical activity in a wide sector of the population. The main secondary effect is the appearance of infections from bacteria, specifically Staphylococcus aureus and S. epidermidis. This paper describes the development and application of low-density polypropylene meshes coated with a biocompatible and resorbable polymer as a controlled release system of the antibiotic vancomycin. The polymeric coating (a non-cross-linked copolymer of 2-hydroxyethyl methacrylate and 2-acrylamido-2-methylpropanesulfonic acid) has a thickness of 14–15μm and contains 0.32mgcm−2 of the antibiotic vancomycin. The in vitro experiments demonstrate the excellent inhibitory character of the coated meshes loaded with the antibiotic, following the standard protocol of inhibition of halo in agar diffusion test. This inhibitory effect is maintained for a relatively long period (at least 14days) with a low concentration of antibiotic. The acrylic polymer system regulates the release of the antibiotic with a rate of 24μgh−1, due to its slow dissolution in the medium. Experiments in vivo, based on the implantation of coated meshes, demonstrate that the system controls the infection in the animal (rabbits) for at least 30days. The concentration of antibiotic in the blood stream of the rabbits was below the detection limit of the analytical technique (<1–2μgml−1), which demonstrates that the antibiotic is released in the local area of the implant and remains concentrated at the implantation site, without diffusion to the blood stream. The systems can be applied to other medical devices and implants for the application of new-generation antibiotics in a controlled release and targeted applications. [Copyright &y& Elsevier]

Abstract: The objective of this study is to develop an automatic clip localization procedure for breast cancer patient setup based on Digital Tomosynthesis (DTS) and to characterize its performance with respect to the overall registration accuracy and robustness. The study was performed under an IRB-approved protocol for 12 breast cancer patients with surgical clips implanted around the tumor cavity. The registration of DTS images to planning CTs was performed using an automatic algorithm developed to overcome specific challenges of localization and registration of clips in the breast setup images. The automatic method consisted of auto-segmentation (intensity-based thresholding with a priori knowledge about clip size and location to distinguish clips from bony features) and auto-registration of the segmented clip clusters. To determine the inherent accuracy and robustness of the registration algorithm, additional simulated DTS data was analyzed. The developed algorithm is efficient in removing false positives and negatives and provides an accuracy of better than 2.3mm for 60° and 3.3mm for 40° DTS. When incorporated in clinical software, this algorithm helps to facilitate fast and accurate setup evaluation with minimal dose delivered to patients. [Copyright &y& Elsevier]

Question: : Can a session of exercise with incorporated expiratory manoeuvres substitute for a session of breathing techniques for airway clearance in children with cystic fibrosis? Are children with cystic fibrosis as co-operative and satisfied with the exercise regimen as with the breathing techniques?. Design: Randomised, cross-over trial with concealed allocation and intention-to-treat analysis. Participants: 34 children with cystic fibrosis in a stable clinical state. Interventions: Participants underwent two 20-min airway clearance interventions on two scheduled clinic days: one involving three bouts of various whole-body exercise modalities each followed by independent expiratory manoeuvres, and the other involving breathing control, thoracic expansions with manual expiratory compressions, and the forced expiratory technique. Outcome measures: Wet weight of expectorated sputum, change in lung function, co-operation with treatment, perceived treatment quality, and satisfaction with treatment were all assessed after each intervention. Results: The wet weight of sputum after exercise was 0.6g higher after the exercise intervention, which was not statistically or clinically significant (95% CI –0.2 to 1.4). However, lung function and participant satisfaction with the treatment were both significantly better after the exercise intervention. Co-operation with treatment and perceived treatment quality were equally high for each intervention. Conclusion: A session of various whole-body exercises interspersed with independent expiratory manoeuvres could be an acceptable substitute for a session of breathing control, thoracic expansions with manual expiratory compressions, and the forced expiratory technique in children with mild cystic fibrosis lung disease. [ABSTRACT FROM AUTHOR]

Abstract: The combination of Surface Plasmon Resonance technology with Mass Spectrometry becomes a key method for the characterization of targeted proteins in the fields of diagnosis and functional proteomics. We demonstrated in this work the ability of our SPRi-chip to capture targeted protein in biological fluids and in situ analyze by MS and MS/MS modes through automated procedure to go beyond classical immunoassays. Here, we established a proof of concept of SUPRA-MS for the detection, the identification and the characterization of a potential breast cancer marker. [Copyright &y& Elsevier]

Abstract: Purpose: Kilovoltage flat-panel imaging systems are used for cone-beam Computed Tomography (CBCT) and digital Tomosynthesis (DTS). Hereby, the presence of scatter and relatively large dose from imaging are challenging factors. In this study a phenomenological beam model was developed to characterize imager response to imaging beams with a bow-tie filter (Varian OBI system). Materials and method: The kilovoltage beam model was based on dose ratio formalism and thus was using standard concepts of megavoltage dose calculation such as scatter factors, tissue maximum ratio and off-axis ratio. Primary and scatter (head and phantom scatter) were modeled with three Gaussian kernels. Parameters were based on measured transmission images for slabs of solid water of different total thickness and various jaw settings. Results: The beam model was used to evaluate contributions from primary, secondary and tertiary contributions for different geometrical objects such as cylinders and step-like phantoms. Theoretical predictions of radiographs using the model for known objects are consistent with the measurements. Conclusion: Secondary and tertiary contributions were interpreted as scatter and can be subtracted from CBCT projections based on the analytical model. Therefore our model can provide a basis for improvement of image quality (less artifacts due to scatter, better contrast and resolution) in CBCT reconstruction. [Copyright &y& Elsevier]

Abstract: Aphid populations, including a widespread pest, Myzus persicae, are known to be affected by cultural practices, plant growth and natural regulation, but their control in orchards most frequently relies on regular treatments aiming to avoid direct damage and virus transmission. This study aimed first at characterising farmers’ management strategies towards aphids and, secondly evaluating them in terms of efficiency and impact on aphid natural enemies. Protection methods were first identified through semi-open interviews and peach orchard pesticide records from 19 organic and conventional fruit farms in south-eastern France. It appeared that in addition to the regular use of direct control, farmers also used cultural and/or alternative methods and various decision-making indicators to optimise their orchard crop protection. Comprehensive variables based on the technical guidelines of the IOBC (International Organisation for Biological and Integrated Control) for crop protection made it possible to differentiate four strategies: intensive, optimised, input-substitution and integrated. Visual monitoring of aphid infestations and of beneficial populations was performed at the plot level. Brachycaudus schwartzi and Myzus varians were the most frequently encountered aphid species but the structures of the communities were affected by protection strategies: the more integrated the strategy, the more diverse and abundant the aphids. The two most effective strategies were dominated by chemical treatments, whereas the other two, less detrimental to aphid antagonists, were mostly carried out by organic farmers. Variations in aphid communities were related to: (i) the use of toxic products, correlated with low-infestations and low-abundance and diversity of antagonists; (ii) alternative and cultural methods (such as mowed ground cover and manual pruning of infested branches, respectively) that promoted high populations of both guilds. Unexpectedly, the structures of these communities were not related to the number of treatments, management of tree vigour or of the surrounding environment. The four strategies identified can be further interpreted as steps towards a redesign of orchard protection where integrated organic farming would be the most advanced stage. However, the paradox between effective protection strategy and biodiversity conservation still remains, casting doubts on the agroecological concept of sustainability. [Copyright &y& Elsevier]

Abstract: The French Indonesian research programs, both conducted on land and offshore in the Banda Sea basins area, have led us to formulate a new interpretation of the East Indonesian geological components. In this area we distinguish, within the three main tectonic plates (Eurasian, Indo-Australian and Philippine–Pacific), seven blocks. Six blocks are deciphered as issued from the north-eastern Gondwanan margin and only one (the Halmahera block) issued from the Pacific plate. Among the Gondwanan blocks, two of them, namely Timor (probably originates from “Greater India”) and Kolonodale (or the Argo block) came from the north-west Australian margin. The Lucipara, Seram and Banggai–Sula blocks originated from the western extension of the Papua-New Guinea Island while the Irian Jaya block is still linked to the North Australian margin. The last one, the Halmahera block, originated from the Pacific plate, moved westward along the North Papua-New-Guinea margin up to its present position in the northern part of the Banda Sea area. Our interpretation is mainly based on the lithostratigraphic succession, the geological evolution and the Early Mesozoic paleoposition of these blocks with respect to the climatic environment deduced from micropaleontological studies. According to previous studies, the Timor and Kolonodale blocks were detached from Gondwana during the Jurassic whereas the Lucipara, Seram and Banggai–Sula blocks were detached from Papua-New Guinea Island during the Neogene period. All these Gondwanan blocks collided with the Eurasian active margin, in the vicinity of Sulawesi Island: Timor and Kolonodale had joined the Eurasian margin by the end of the Paleogene, while Lucipara, Seram and Banggai–Sula collided with Sulawesi Island between the Middle Miocene to Middle Pliocene. After the collisions the last three blocks together with the Kolonodale block did not move again but suffered the opening of North and South Banda back-arc basins, by the Late Miocene. On the contrary, part of the Timor block moved south together with the southern margin of the south Banda basin and, later on during the middle Pliocene, collided with the northern Australian margin. The detachment of these blocks from the Gondwana margin, and their amalgamation with the Eurasian margin, are discussed and illustrated through palaeogeographic maps. [Copyright &y& Elsevier]

Abstract: After the Gondwana break-up and Greater India splitting off, Madagascar suffered volcanic episodes. The Cretaceous Morondava flood basalt (CFB) province was emplaced ca. 93Ma ago. Two coeval high-Ti–P (HTP) and low-Ti–P (LTP) suites are distributed within the alkaline Ankilizato (central) and tholeiitic Manamana (southern) sub-provinces. Sr–Nd isotope compositions display a trend from depleted (ε Nd =+7.5; Sri =0.7030; Antsoha end-member) to highly enriched products (ε Nd =−17; Sri =0.7228; Manamana end-member). Antsoha end-member is considered to be located at the lithosphere–asthenosphere boundary while the composition of Manamana end-member implies a location within the Archean to Proterozoic continental lithosphere. Oligocene Ankaratra HTP alkaline province, Miocene Ankilioaka transitional province, Pliocene Ambre Mountain and Pleistocene Nosy Be Island alkaline volcanoes display a restricted isotopic range (ε Nd =+4 to 0; Sri =0.7032 to 0.7048) forming an array distinct from the Cretaceous trend, implying the enriched pole did not correspond to Manamana end-member. This Cenozoic array could result from mixing between Antsoha end-member and BSE or a pole beyond. The exceptional variation of mantle sources involved in the Cretaceous episode contrasts with the more homogeneous near-BSE source during the Cenozoic. Several lines of evidence dismiss the mantle plume model. Cretaceous volcanism resulted from reactivation of a lithospheric scale shear zone due to plate reorganisation that eventually led to the Madagascar–India continental break-up. The lower lithospheric/asthenospheric melt (Antshoha end-member) was able to melt the most enriched/fusible parts of an upper lithospheric mantle (Manamana end-member); these two melts partly mixed. Long-lasting Neogene volcanic activity was less voluminous. The melting source was restricted to a lower part of the lithospheric mantle. [Copyright &y& Elsevier]

Abstract: The goal oriented framework (GOF) for indicators has been developed as part of a comprehensive research project developing computerised tools for integrated assessment of the effects of new policies or technologies on agricultural systems (SEAMLESS-IF). The ambition has therefore been to create an indicator framework where the environmental, economic and social dimensions of sustainable development can be related to each other in a consistent way. Integrated assessment tools rely on such frameworks to capture and visualise trade-offs (antagonisms or synergies) among indicators between and within the three dimensions of sustainable development. The specific aims of this paper are to (i) present the GOF (ii) present how the GOF can be used to select indicators within the integrated assessment framework SEAMLESS-IF and (iii) discuss the advantages and limitations with the proposed approach. We show that the GOF has several advantages. Its major rewards are its relative simplicity and the possibility to link indicators to policy goals of each dimension of sustainability and thereby facilitate the comparison of the impacts of the new policy on the different dimensions. Another important feature of the GOF is its multi-scale perspective, which will enable the comparison of effects of a new policy between scales. Yet, as typical for all indicator frameworks, the GOF has also biases either instigated by the issues the included models cover or by the stakeholders’ selection of indicators. However, due to the way the GOF and its indicators are technically implemented in SEAMLESS-IF, it can easily be extended and include new indicators to increase and update its policy relevance. [Copyright &y& Elsevier]

• A forest sector economic model was coupled with Life Cycle Assessment. • Adaptations were made to ensure consistency between the two approaches. • Two types of eco-efficiency ratios were developed, including or not avoided impacts. • We tested this framework with a fuelwood subsidy in the French Grand Est Region. • The subsidy increases Eco-efficiency for the 3 endpoint indicators, by 5 to 50%. An innovative modelling framework and metrics are developed to assess the economic and environmental performances of regional incentives in the wood energy sector. Our approach is based on the coupling between a partial equilibrium economic model of the forest sector with Life Cycle Assessment (LCA). Its originality relies on the computation of regional eco-efficiency ratios while taking account of diverse direct and indirect spatial and market interactions. Several adaptations were implemented to ensure consistency between the two modelling approaches in terms of process yields and flow balances. These adaptations make it possible to produce both economic and environmental indicators with a consistent perimeter. Finally, we used two kinds of eco-efficiency indicators to compare bioenergy policies. On the one hand, Partial Eco-Efficiency (PEE) combines the economic surplus induced by an incentive on the energy wood sector with its potential environmental impacts. On the other hand, Full Eco-Efficiency (FEE) adds the environmental impacts avoided by substitution between wood-energy and fossil fuels, compared to a business-as-usual (BAU) scenario. The proposed adaptations were applied to a case study in the French Grand Est region that compared the eco-efficiency of scenarios with or without a subsidy to wood energy consumption. Results show that subsidy increases the eco-efficiency of the forest-based sector using both PEE and FEE while keeping competition with the other regions to a minimum. However, most benefits come from the consideration of avoided impacts, with FEE far exceeding PEE. Using FEE, the scenario with the subsidy is 5% to 50% more eco-efficient than the BAU despite an increased consumption of wood products, due to economic gains and avoided impacts. These outcomes show the importance of considering potential trade-offs when assessing the economic and environmental performance of regional policies in favour of the bioeconomy. [Display omitted] [ABSTRACT FROM AUTHOR]

Three children with cartilage-hair hypoplasia presented with chronic obstructive symptoms and bronchiolar wall thickening on high-resolution computed tomography scanning. In all children, surgical lung biopsy demonstrated diffuse dilated lymphoplasmacytic bronchiolitis. The bronchiolar wall was infiltrated by a lymphocyte sheath with plasma cell differentiation and dispersed secondary follicles. Clarithromycin substantially improved respiratory symptoms and pulmonary function, allowing children to return home. [Copyright &y& Elsevier]

Background & Aims: The effects of fat on gastric emptying (GE), gut hormones, and energy intake are dependent on digestion to free fatty acids (FFAs). In animals, small intestinal oleic acid inhibits energy intake more potently than the triacylglyceride (TG) triolein, but there is limited information about the comparative effects of FFA and TG in human beings. We compared the effects of FFA and TG on GE, gut hormone secretion, appetite, and energy intake in healthy males. Methods: Nine men (age, 23 ± 2 y; body mass index, 22 ± 1 kg/m2) were studied on 3 occasions to evaluate the effects of (1) 40 g oleic acid (FFA, 1830 kJ), (2) 40 g macadamia oil (TG, 1856 kJ; both 600-mL oil-in-water emulsions stabilized with 4% milk protein and labeled with 15 MBq 123I), or (3) 600 mL 4% milk protein (control, 352 kJ), administered intragastrically, on GE, plasma cholecystokinin (CCK) and peptide-YY (PYY) levels, appetite perceptions, and subsequent energy intake. Results: GE of FFA was much slower than that of TG (P < .05), with greater retention of FFA, than TG, in the proximal stomach (P < .001). Hunger was less (P < .05), and fullness was greater (P < .05), after FFA when compared with control and TG. Increases in plasma CCK and PYY levels were greater after FFA than TG or control (P < .05). Energy intake tended to be less after FFA compared with TG (control, 4754 ± 610 kJ; TG, 5463 ± 662 kJ; FFA, 4199 ± 410 kJ). Conclusions: FFAs empty from the stomach more slowly, but stimulate CCK and PYY and suppress appetite more potently than TG in healthy human beings. [Copyright &y& Elsevier]

Objective: To assess whether pulmonary arteriovenous malformation (PAVM) is associated with hereditary hemorrhagic telangiectasia (HHT). Study design: This study was a review of 12 children (sex ratio = 1) including family history, mutation analysis, and long-term follow-up. Results: Five children were under age 3 years when PAVM was diagnosed. Presentations included pulmonary symptoms (n = 8), cerebral abscess (n = 2), and transient ischemic attack (TIA) (n = 1); 1 patient was asymptomatic. Nine of the 12 children (75%) had a family history of PAVM. The diagnosis of HHT was confirmed in all cases. A mutation in ENG was found in 9 of the 10 children available for testing. No mutation in ACVRL1 was found. During long-term follow-up (mean, 16 years), the following complications occurred: TIA (n = 2), hemoptysis (n = 2), and cerebral abscess (n = 2). Nine children experienced recurrence of PAVM. The children with no recurrence were those without a family history of PAVM. Conclusions: The diagnosis of HHT should be considered in a child with an apparently isolated PAVM. Because serious complications may occur at any age, we recommend screening for PAVM and long-term follow-up in children from families with HHT, especially those with an ENG mutation. [Copyright &y& Elsevier]

Summary: This review will address: (1) ‘what are the current indications for radiation therapy (RT), following both mastectomy and breast-conserving surgery?’ and (2) ‘if RT is indicated, what are the appropriate volumes or ‘targets’ to be treated?’ Given the complexity of these questions, this review will focus on selected topics considered of greatest current interest. In addition, this review will primarily focus on results obtained from randomized clinical trials (RCTs). Finally, we acknowledge an American point of view in our discussion. [Copyright &y& Elsevier]

Rationale and objectives: This report presents a computational approach to help the gestational age determination of newborns. Gestational age knowledge is fundamental to guide postnatal treatment and increase survival chances of newborns. However, current methods are invasive and do not generate precise results, mainly because they were developed based on nonpremature populations. Materials and methods: We developed an original and noninvasive method to help determination of gestational age based on information supplied by plantar surface images. These images present many details and patterns, but, to date, have not received attention from the image-processing community. We provide a computational tool with suitable facilities to allow the image analysis, either automatically or user driven. This image-processing tool is presented here. Results: The image-processing tool was developed on a user-driven basis. However, as a quantitative experiment, 186 images were processed without user intervention to observe tool behavior in performing different tasks. Although preliminary, experimental results confirm the relationship between plantar surface features and gestational age. Conclusion: A prototype of the FootScanAge System is being used and evaluated by experts in neonatology. By means of digital processing of plantar surface images, some characteristics may be shown. Some hypotheses regarding the method have already been confirmed. Also, we show that some well-known image-processing techniques, if appropriately adapted, lead to suitable results when applied to plantar surface images. [Copyright &y& Elsevier]

A small proportion of patients with EB develop genitourinary disorders, which can nevertheless have a major impact on their morbidity. We present the case of a 7-year-old boy with junctional EB who presented with dysuria and lower back pain caused by bladder lithiasis complicating posterior urethral stenosis, surgical management, and postoperative outcomes. [ABSTRACT FROM AUTHOR]

Collagens and glycosaminoglycans were assessed in 6 leiomyomas from otherwise healthy ("control") patients and 1 leiomyoma from a patient with type IV Ehlers-Danlos syndrome. The type IV Ehlers-Danlos leiomyoma contained less type III collagen and dermatan sulfate than control leiomyomas. This might contribute to the formation of a defective collagen network in type IV Ehlers-Danlos syndrome. [ABSTRACT FROM AUTHOR]

The article discusses research on the effectiveness of trastuzumab plus radiotherapy in chemotherapy-refractory, locally advanced or loco-regionally recurrent breast cancer patients. It references a study by J. K. Horton and colleagues published in a 2010 issue of "International Journal of Radiation Oncology Biology Physics." The researchers reported that after receiving trastuzumab and undergoing radiotherapy, Grade 3 toxicities include lymphopenia.

The study was aimed at assessing the suitability of English-language Internet health information related to vocal hygiene, vocal health, and prevention of voice disorders. We also examined the relation between suitability, readability, and quality of Internet health information. Suitability of 77 websites from Dueppen et al9 was assessed using the Suitability Assessment of Materials tool. Information about readability and quality of the websites were extracted from Dueppen et al.9 The overall converted suitability percent score of all 77 websites was 66.4%, which represents "adequate" suitability. Individual websites were rated as superior (ie, 44.2%) adequate (ie, 51.9%), and not suitable (ie, 3.9%). No relation was found between website origin and the suitability ratings. The inter-rater reliability of the Suitability Assessment of Materials ratings for overall scale was found to be good. The suitability of websites had a moderate correlation with readability measures, but no significant correlation was observed between the suitability and quality of websites. The study results suggest that overall suitability of websites on vocal hygiene are adequate. However, many websites may require improvements in some elements (eg, literacy demand, graphics, and learning stimulation). Readability, quality, and suitability are important components in the accessibility of health information for people with different health conditions. Hence, improvements in these elements are expected to improve the understanding and actionability of people with voice issues. [ABSTRACT FROM AUTHOR]