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• Extreme hypofractionated radiation is a regimen delivering >5 Gy/fraction. • It is a safe alternative to normofractionation in locoregional radiation setting. • It confers excellent oncologic outcomes in term of locoregional control and survival. Breast cancer locoregional (LR) radiation in the elderly requires careful consideration between the benefits of aggressive treatment and its potential toll on these patients. Extreme weekly LR hypofractionated radiation (HFRT), delivering >5 Gy per fraction, may be better suited in such a population. It represents a good compromise between RT omission and exhaustive daily radiation. This study aims to report the local and LR control rate as well as the acute and long-term side effects of the elderly patients treated with HFRT in our institution, and to compare these results to those from the literature. We conducted a retrospective study by reviewing medical records of elderly patients with breast cancer treated with adjuvant once-weekly LR HFRT between 2011 and 2020. Fifty patients presenting with primary non-metastatic node-positive breast tumors were included. Treatment outcomes including local/LR control and overall survival were reported. Early and late toxicity profiles were also assessed. After a median follow-up of 4.8 years, only one local recurrence in the chest wall occurred and there was no regional recurrence. The distant metastatic rate was 6%. The long-term recurrence-free survival rate was 80% at 5 years. The cause specific survival rate was 90% at 5 years. The overall survival rate was 69.4% and 55.5% at 3 and 5 years, respectively. There were 44 (88%) patients with Grade 1 or 2 early toxicity. There was no Grade 3 or higher acute toxicity registered. Late toxicity was mainly Grade 1 or 2 subcutaneous fibrosis, lymphoedema, and neuropathy except for one patient with Grade 3 fibrosis. Extreme LR HFRT is well tolerated with good outcomes and is a good alternative for elderly and frail patients. Our results confirm the efficacy and safety of such a regimen. Further randomized trials assessing both oncologic outcome and toxicity profile are justified. [ABSTRACT FROM AUTHOR]

Abstract: Fine control over the functional expression of cardiac ion channels is required to maintain normal action potential (AP) duration and QTc times. A growing number of drugs interfere with normal trafficking of ion channels to and from the plasma membrane, thereby altering the number of channels on the cell surface. Most drugs do this at clinically relevant concentrations, which may lead to potentially life-threatening cardiac arrhythmias. Recently, major progress has been made in the understanding of the subcellular mechanisms by which drugs affect the trafficking of ion channels, which is of great benefit for the development of ways to counteract these adverse drug effects. Pharmacological correction seems to be a promising approach to address the trafficking defects induced by several drugs. However, as pharmacological correction is hampered by concomitant direct channel block or unspecific effects, further studies are needed to improve its potential as a clinical therapy. [Copyright &y& Elsevier]

Abstract: Background: Almost half of the global traffic crashes involve vulnerable groups such as pedestrian, cyclists and two-wheeler users. The main objective of this study was to determine the factors that influence standard of the safety helmets used amongst food delivery workers by presence of Standard and Industrial Research Institute of Malaysia (SIRIM) certification label. Methods: A cross sectional study was conducted amongst 150 food delivery workers from fast food outlets in the vicinity of Selangor and Kuala Lumpur. During observation, safety helmets were classified as standard safety helmet in the presence of SIRIM label and non-standard in the absence of the label. They were approached for questionnaire participation once consent was obtained and were requested to exchange their safety helmet voluntarily with a new one after the interview. Data analysis was carried out using SPSS. Chi square and logistic regression analysis was applied to determine the significance and odds ratio of the variables studied, respectively (penetration test, age, education level, knowledge, crash history, types of safety helmet, marital status and years of riding experience) against the presence of SIRIM label. Results: The response rate for this study was 85.2%. The prevalence of non-standard helmets use amongst fast food delivery workers was 55.3%. Safety helmets that failed the penetration test had higher odds of being non-standard helmets compared with safety helmets passing the test. Types of safety helmet indicated half-shell safety helmets had higher odds to be non-standard safety helmets compared to full-shell safety helmets. Riders with more years of riding experience were in high odds of wearing non-standard safety helmets compared to riders with less riding experience. Conclusion: Non-standard (non-SIRIM approved) helmets were more likely to be half-shell helmets, were more likely to fail the standards penetration test, and were more likely to be worn by older, more experienced riders. The implications of these findings are discussed. [Copyright &y& Elsevier]

Abstract: CO2-enhanced oil recovery projects have been the initial areas of focus for advancing geological storage of CO2 as a key greenhouse gas mitigation option. Canada has provided international leadership through the IEA GHG Weyburn CO2 Monitoring and Storage Project. In late 2004, a CO2 EOR flood pilot within the Cretaceous Cardium Formation within the Pembina oil field in Central Alberta was selected as the site for a comprehensive CO2 monitoring program. This pilot, completed in 2008 has tested the deployment of new CO2 flood monitoring tools, allowing for a better understanding of the behaviour of CO2 in the largest conventional reservoir in Canada and one of the largest in North America. The Pembina Cardium pilot has resulted in scientific advances related to the integration of different CO2 monitoring technologies (reservoir surveillance, geochemistry, geophysical, environmental, reservoir simulation). The project’s findings will inform new protocols concerning the deployment of downhole technologies in observation wells used for the monitoring and verification of CO2 movement in the subsurface. [Copyright &y& Elsevier]

This presentation will describe factors contributing to increased transition risk of youth in foster care and identify how promising practices would improve their transition to adulthood. Federal policy recognizes a state responsibility to act in the parent role for youth in foster care transitioning to adulthood and to provide transition services. [Extracted from the article]

The low α\β ratio of 1.2 to 2 for prostate cancer (PCa) suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of hypofractionated (HF) radiation therapy (RT). To date, no phase 3 randomized clinical trial has compared moderately HF RT with standard fractionation (SF) exclusively in high-risk PCa patients. We are reporting the safety of moderate HF RT in high-risk PCa in an initially noninferiority-designed phase 3 clinical trial. From February 2012 to March 2015, 329 high-risk PCa patients were randomized to receive either SF or HF RT. All patients received neoadjuvant, concurrent, and long-term adjuvant androgen deprivation therapy. Standard fractionation RT consisted of 76 Gy in 2 Gy per fraction to the prostate, where 46 Gy was delivered to the pelvic lymph nodes. Hypofractionated RT included concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate and 45 Gy in 1.8 Gy per fraction to the pelvic lymph nodes. The coprimary endpoints were acute and delayed toxicity at 6 and 24 months, respectively. The trial was originally designed as a noninferiority with a 5% absolute margin. Given the lower-than-expected toxicities in both arms, the noninferiority analysis was completely dropped. Of the 329 patients, 164 were randomized to the HF and 165 to the SF arms. In total, there were more grade 1 or worse acute gastrointestinal (GI) events in the HF arm, 102 versus 83 events in the HF and SF arm, respectively (P =.016). This did not remain significant at 8 weeks of follow-up. There were no differences in grade 1 or worse acute GU events in the 2 arms, 105 versus 99 events in the HF and SF arm, respectively (P =.3). At 24 months, 12 patients in the SF arm and 15 patients in the HF arm had grade 2 or worse delayed GI-related adverse events (hazard ratio, 1.32; 95% CI, 0.62-2.83; P =.482). There were 11 patients in the SF arm and 3 patients in the HF arm with grade 2 or higher delayed genitourinary (GU) toxicities (hazard ratio, 0.26; 95% CI, 0.07-0.94; P =.037). There were 3 grade 3 GI and one grade 3 GU delayed toxicities in the HF arm and 3 grade 3 GU and no grade 3 GI toxicities in the SF arm. No grade 4-toxicities were reported. This is the first study of moderate HF dose-escalated RT in exclusively high-risk patients with prostate cancer treated with long-term androgen deprivation therapy and pelvic RT. Although our data were not analyzed as a noninferiority, our results demonstrate that moderately HF RT is well-tolerated, similar to SF RT at 2 years, and could be considered an alternative to SF RT. [ABSTRACT FROM AUTHOR]

Intravascular brachytherapy (IVBT) is a modality of radiation therapy used to treat in-stent restenosis. Drug-eluting stents have become the first line therapy for the treatment of ISR, but IVBT remains critical for treatment of patients whose drug-eluting stents fail. However, current clinical dosimetry for IVBT is water-based, i.e., absorbed dose in the target volume is calculated by assuming that the patient's artery, calcified plaques, metallic stents, and guidewire from the IVBT delivery system are all water with unit mass density. We have previously shown with Monte Carlo simulations in an artery model that target dose due to these heterogeneities could be as low as 60% of the planned dose. Vascular optical coherence tomography (OCT) is an imaging modality that utilizes near-infrared light to image the IVBT treatment area, visualizing calcification, stents, and the guidewire. We are particularly concerned about the potential for cold spots in situations where multiple stents overlap. Vascular OCT is currently the only clinically available imaging modality which can detect overlapping stents prior to treatment. The purpose of this study was to continue to investigate the uncertainties in water-based IVBT dosimetry by extending our previous software to account for patient-specific geometry from OCT images. Monte Carlo treatment planning software based on the Geant4 toolkit v. 10.02.p02 was developed. A Novoste Beta-Cath 3.5F IVBT device with a Sr-90/Y-90 source train was simulated. OCT images from a patient at Brigham and Women's Hospital in Boston, Massachusetts undergoing coronary IVBT for recurrent ISR, were used to calculate the absorbed dose with the developed software taking all heterogeneities into account compared to dose calculated in water. The patient artery was segmented as water (lumen), calcified plaque (around the lumen), smooth muscle (tunica media) and stainless steel (guidewire and stents). Simulations were performed on the Digital Research Alliance of Canada Narval computing cluster with 1 billion decay events to yield less than 1% uncertainty on absorbed dose in the target volume. The absorbed dose was scored in rectangular voxels of 0.05 mm by 0.05 mm in the axial plane of the artery and 4.2 mm thickness along the 42 mm length including the stents, source train and an additional 2 mm margin. The prescribed dose was 23 Gy to the target volume, at 2.0 mm from the source center. There was severe under-dosing of radiation behind the guidewire (up to 80%), and the stents (up to 50%). The dose distribution around the source in the patient-specific simulation was non-homogenous due to the guidewire, the stents and calcification. Monte Carlo dose calculation software for IVBT was developed, where accurate attenuation of the dose by heterogeneities is considered. Patient treatments based on water dosimetry is inaccurate, and model-based dose calculation methods should be considered. [ABSTRACT FROM AUTHOR]

The present work contributes to a better understanding of the basic assumptions and principles behind the design of Ni-based single crystal superalloys (SXs). For this purpose, we cast and heat-treat four SXs and compare their creep performances: ERBO/1 (with Re) and three ERBO/15 variants (no Re but increased levels of Ti, Mo and W). We show that Re can be replaced by other elements without losing creep strength. To come to this conclusion one has to consider both, alloy composition and microstructure. We analyze the mechanical, microstructural and chemical results (creep rates, γʼ-volume fractions, average γʼ-particle sizes, average γ-channel widths and the chemistry of γ- and γʼ-phases) obtained for ERBO/15 and its two leaner variants (less Mo: ERBO/15-Mo and less W: ERBO/15-W). ERBO/15-Mo and ERBO/15-W show higher creep rates than ERBO/15, because they exhibit lower Mo and W concentrations in the γ-channels. This results in higher diffusion rates, accelerated rafting and faster dislocation climb at γ/γʼ-interfaces. Unlabelled Image • A computer aided newly developed Ni-base superalloy without Re outperforms the creep performance of a CMSX-4 type with Re. • Adjustment of overall alloy composition and microstructure are equally important for alloy design. • The influence of an individual element on creep has to be analyzed by changing the concentration of this and the base element. • Reduction of the nominal concentration of Mo or W in the Re-free superalloy results in significantly higher creep rates. • These higher creep rates can be explained by lower concentrations of Mo or W in the γ-channels. [ABSTRACT FROM AUTHOR]

The goals of this session are to outline a rationale for developing clinical guidelines for the practice of "deprescribing" in child and adolescent psychiatry; to describe the methodology of conducting a systematic search on a seldom-studied topic; and to present challenges and limitations of various search strategies. To evaluate comprehensiveness of search results from each database, we checked whether any of 10 articles, randomly selected from a list of publications known to be relevant, were present in the search results as a sensitivity test. [Extracted from the article]

Febrile neutropenia is generally recognised as a complication of myelosuppressive chemotherapy. Recombinant human granulocyte colony stimulating factor (G-CSF) is commonly used as a primary or secondary prophylaxis to reduce the degree and duration of neutropenia in patients at risk of developing chemotherapy-induced neutropenic fever and infectious complications. G-CSF is known to decrease mortality and increase the possibility of maintaining adequate chemotherapy dose intensity and density, which is essential in curable malignancies. Common side effects are generally mild. However, potentially fatal adverse events have also been reported. Herein, we summarise previously reported and report two new independent cases of G-CSF-induced aortitis, both in patients treated with chemotherapy for breast cancer. The two cases, identified only a few months apart, share several common characteristics including type of cancer, gender, age, chemotherapy, G-CSF treatment regimen, and time span from G-CSF initiation to aortitis manifestation. The two cases were both diagnosed by CT scan and successfully treated with corticosteroids along with discontinuation of G-CSF. This case report highlights that although aortitis is a rare adverse event of G-CSF treatment, it should be considered in cases of unexplained fever and/or clinical and laboratory findings that do not respond to antibiotics. [ABSTRACT FROM AUTHOR]