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BACKGROUND Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of overweight or obese children aged 5–19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. OBJECTIVE The present study aims to investigate the potential impact of the mobile application Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. METHODS Participants were recruited via the Heia Meg app, and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (pre-intervention) questionnaire, while 99 valid responses were obtained in the second (post-intervention) questionnaire. RESULTS The majority of participants were women, and their age ranged from 18 years to 70 years and older. Men had a higher Body Mass Index (BMI) than women, but had a higher health score. The results show a reduction in BMI after the digital intervention, but a higher health score was observed in the pre-intervention group. The BMI accounted for a significant amount of variance in the individual’s health score for both groups (26.22% & 18.63%). Regression analysis showed that gender, age, education, smoking, and BMI had a statistically significant effect and accounted for a significant amount of variance (44% & 35%) in the health score. CONCLUSIONS Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research is needed to confirm our findings. Keywords: lifestyle change, motivation, health, smartphone applications, Heia Meg CLINICALTRIAL Norwegian senter of research 385157

Purpose Treatment planning for proton therapy requires the relative proton stopping power ratio (RSP) information of the patient for accurate dose calculations. RSP are conventionally obtained after mapping of the Hounsfield units (HU) from a calibrated patient computed tomography (CT). One or multiple CT are needed for a given treatment which represents additional, undesired dose to the patient. For prostate cancer, magnetic resonance imaging (MRI) scans are the gold standard for segmentation while offering dose-less imaging. We here quantify the clinical applicability of converted MR images as a substitute for intensity modulated proton therapy (IMPT) treatment of the prostate. Methods MRCAT (Magnetic Resonance for Calculating ATtenuation) is a Philips-developed technology which produces a synthetic CT image consisting of five HU from a specific set of MRI acquisitions. MRCAT and original planning CT data sets were obtained for ten patients. An IMPT plan was generated on the MRCAT for each patient. Plans were produced such that they fulfill the prostate protocol in use at Massachusetts General Hospital (MGH). The plans were then recomputed onto the nominal planning CT for each patient. Robustness analyses (±5 mm setup shifts and ±3.5 % range uncertainties) were also performed. Results Comparison of MRCAT plans and their recomputation onto the planning CT plan showed excellent agreement. Likewise, dose perturbations due to setup shifts and range uncertainties were well within clinical acceptance demonstrating the clinical viability of the approach. Conclusions This work demonstrate the clinical acceptability of substituting MR converted RSP images instead of CT for IMPT planning of prostate cancer. This further translates into higher contouring accuracy along with lesser imaging dose.

Organoids are laboratory-grown 3D organ models, mimicking human organs for e.g. drug development and personalized therapy. Islet organoids (typically 100-200 μm), which can be grown from the patient’s own cells, are emerging as prototypes for transplantation-based therapy of diabetes. Selective methods for quantifying insulin production from islet organoids are needed, but sensitivity and carry-over have been major bottlenecks in previous efforts. We have developed a reverse phase liquid chromatography-tandem mass spectrometry (RPLC-MS/MS) method for studying the insulin secretion of islet organoids. In contrast to our previous attempts using nano-scale LC columns, conventional 2.1 mm inner diameter LC column (combined with triple quadrupole mass spectrometry) was well suited for sensitive and selective measurements of insulin secreted from islet organoids with low microliter-scale samples. Insulin is highly prone to carry-over, so standard tubings and injector parts were replaced with shielded fused silica nanoViper™ connectors. As samples were expected to be very limited, an extended Box-Behnken experimental design for the MS settings was conducted to maximize performance. The finale method has excellent sensitivity, accuracy and precision (limit of detection: ≤ 0.2 pg/μL, relative error: ≤ ±10%, relative standard deviation: < 10%), and was well suited for measuring 20 μL amounts of Krebs buffer containing insulin secreted from islet organoids.

Obesity is a common, costly, and life-threatening chronic disease characterized as abnormal or excessive fat buildup that causes a health risk. Overweight and obesity rates in adults and children continue to rise, whereas the frequency of overweight or obese children aged 5–19 years grew more than fourfold from 4% to 18% globally between 1975 and 2016. And in 2017 nearly 4 million individuals died as a result of being overweight or obese. The present study investigated the usage of the application Heia Meg, and the effect of taking healthier lifestyle decisions regarding nutrition and physical activity. A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the application Heia Meg. All users downloading the app between October 4, 2021, and November 5, 2021, received a message containing an informed consent form and a link to the questionnaire. In the first (pre-intervention) questionnaire, 199 responses were included, while in the second one (post-intervention), there were 99 valid responses. Women outnumbered men in terms of participation, in both questionnaires, and age ranged from 18 years to 70 years and older. Men appear to have a higher Body Mass Index than woman, where both genders seem to be overweighted or grade I obese. Furthermore, when looking at the participants health score, men seem to have a higher health score than women. Results: By analyzing the effect of the digital intervention on the Body Mass Index, a reduction has been observed between post and pre-intervention, while the health score was higher for the pre-intervention group than the post-intervention one. Furthermore, the Body Mass Index was able to account for a significantly amount of variance in the individual’s health score for both groups (26.22% & 18.63%). A regression analysis was performed to assess the effect of independent variables on the health score. Gender, age, education, smoking, and BMI all had a statistically significant effect and accounted for significant amount of variance (44% & 35%). Conclusion: From this study there is weak or no clear evidence to state that the app Heia Meg does lead to better nutrition and physical activity choices. This result can be attributed to the limitations and confounding factors described in the thesis, and further research – in other contexts – is needed to confirm, or not, this conclusion.

Purpose/Objective(s) The role of PORT for patients with resected stage IIIA (N2) NSCLC is controversial. Recently, the Phase III LungART trial reported a significant improvement in mediastinal control with PORT but failed to show an overall survival (OS) benefit, due in part to cardiopulmonary (CP) toxicity (7% early and 20% late grade (G) 3-5). However, LungART employed 3D conformal radiotherapy (3D-CRT) in 90% of patients as well as elective treatment of mediastinal nodal stations. We evaluated the risk of CP toxicity associated with use of postoperative IMRT for this population. Materials/Methods We conducted a retrospective study of consecutive patients with NSCLC treated with postoperative IMRT between 2008 and 2019. Patients were eligible if they were found to have incidental pN2 or an R1/2 resection. Targets of PORT for pN2 were bronchial stump, ipsilateral hilum, and involved mediastinal station(s). The primary objective was incidence of CTCAE (v4) G3+ CP toxicities. Secondary objectives were major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, coronary revascularization or hospitalization due to heart failure; disease-free survival (DFS); and OS. Cumulative incidence and Kaplan-Meier method were used as appropriate. Results 73 patients received PORT with IMRT. Median follow-up was 54 months. Median age at diagnosis was 65 years (range 36 - 81); 33 patients (45%) had pre-existing cardiovascular disease and 48 (65.8%) were current/former smokers. 50 patients had pN2 disease and 23 patients had R1/R2 resection. Among patients with pN2, the median number of involved mediastinal nodes was 1 (range 1 – 12). All patients with pN2 and 70% of patients with R1/R2 resection received chemotherapy, the majority of which was sequential (n = 52, 71.2%). Median RT dose was 54 Gy (range 45 – 66 Gy) in 27 fractions for patients with pN2 and 59.4 Gy (range 45 – 66 Gy) in 30 fractions for patients with R1/R2 resection. 3-year cumulative incidence of G3+ CP toxicity was 2.7%, with an overall incidence of 6.8% (5 events in 73 patients). The rate of G3+ CP toxicity in patients with pN2 was 8%. Three patients developed ≥1 MACE: one died of a cardiac arrest and two underwent coronary revascularization. Two of these patients had a history of coronary artery disease. Two episodes of G3+ toxicity involved valve replacements in patients with pre-existing valvular disease. 3-year DFS was 51.4% (95% CL 46.9 – 55.1%). Two patients with pN2 developed mediastinal failures. 3-year OS was 62.3% (95% CL 50.2 – 74.4%). Conclusion PORT for pN2 NSCLC using IMRT and no elective nodal irradiation is associated with a low rate of G3+ CP toxicity in patients with pN2, comparable to the chemotherapy only arm of the LungART trial. Our data suggest that highly conformal radiation techniques should be prospectively assessed for their potential to translate the known local control benefit of PORT into a survival advantage.

Importance Severe acute esophagitis occurs in up to 20% of patients with locally advanced lung cancer treated with chemoradiation therapy to at least 60 Gy once daily and represents a dose-limiting toxic event associated with poor outcomes. Objective To assess whether formalized sparing of the contralateral esophagus (CE) is associated with reduced risk of severe acute esophagitis. Design, setting, and participants This single-center phase 1 nonrandomized clinical trial assessing an empirical CE-sparing technique enrolled patients from July 2015 to January 2019. In total, 27 patients with locally advanced non-small cell lung carcinoma (with or without solitary brain metastasis) or limited-stage small cell lung carcinoma with gross tumor within 1 cm of the esophagus were eligible. Interventions Intensity-modulated radiation therapy to 70 Gy at 2 Gy/fraction concurrent with standard chemotherapy with or without adjuvant durvalumab. The esophageal wall contralateral to gross tumor was contoured as an avoidance structure to guide a steep dose falloff gradient. Target coverage was prioritized over CE sparing, and 99% of internal and planning target volumes had to be covered by 70 Gy and at least 63 Gy, respectively. Main outcomes and measures The primary end point was the rate of at least grade 3 acute esophagitis as assessed by Common Terminology Criteria for Adverse Events, version 4. Results Of 27 patients enrolled, 25 completed chemoradiation therapy. Nineteen patients had non-small cell lung carcinoma, and 6 had small cell lung carcinoma. The median age at diagnosis was 67 years (range, 51-81 years), and 15 patients (60%) were men. Thirteen patients (52%) had stage IIIA cancer, 10 (40%) had stage IIIB cancer, and 2 (8%) had stage IV cancer. The median CE maximum dose was 66 Gy (range, 44-71 Gy); the median volume of CE receiving at least 55 Gy was 1.4 cm3 (range, 0-5.3 cm3), and the median volume of CE receiving at least 45 Gy was 2.7 cm3 (range, 0-9.2 cm3). The median combined percentage of lung receiving at least 20 Gy was 25% (range, 11%-37%). The median follow-up was 33.3 months (range, 11.1-52.2 months). Among the 20 patients who had treatment breaks of 0 to 3 days and were thus evaluable for the primary end point, the rate of at least grade 3 esophagitis was 0%. Other toxic events observed among all 25 patients included 7 (28%) with grade 2 esophagitis, 3 (12%) with at least grade 2 pneumonitis (including 1 with grade 5), and 2 (8%) with at least grade 3 cardiac toxic event (including 1 with grade 5). There was no isolated local tumor failure. The 2-year progression-free survival rate was 57% (95% CI, 33%-75%), and the 2-year overall survival rate was 67% (95% CI, 45%-82%). Conclusions and relevance This phase 1 nonrandomized clinical trial found that the CE-sparing technique was associated with reduced risk of esophagitis among patients treated uniformly with chemoradiation therapy (to 70 Gy), with no grade 3 or higher esophagitis despite tumor within 1 cm of the esophagus. This technique may be translated into clinical practice. Trial registration ClinicalTrials.gov Identifier: NCT02394548.

Purpose: The purpose of this study was to investigate the effect of ingesting liquid glucose during resistance exercise on protein expression of muscle RING finger 1 (MuRF1) on healthy trained adults after 5 training sessions. Method: Thirteen healthy trained participants performed six sessions of heavy-load resistance training with ingestion of glucose or placebo in this within subject randomized clinical trial. The subjects concluded a three-week intervention, consistent of familiarization phase the first week, and two weeks of resistance exercise. The participants legs were randomized in either glucose (GLU) or placebo (PLA), ingested during or after training session. Blood samples and biopsies were taken before and after intervention. The outcome measures were protein expression on MuRF1, nutrition status, muscle strength, training volume and glucose levels in blood. All data is analyzed in R Studio. Results: Intake of glucose during resistance training led to a 26% [-0.4, -0.6] lower accumulation of protein expression MuRF1 in GLU compared to PLA (48% [0.03, 0.07] increase in post). The intervention led to an increase on total volume (PLA: 19% [0.1, 0.25], GLU: 18% [0.08, 0.24]. There was a time effect on isometric test (PLA: 8% [0.007, 0.16], GLU: 4% [-0.03, 0.12] on test 2, isokinetic 60sek (PLA: -18% [-0.25, -0.10], GLU: 9% [-0.16, -0.01] with significant difference between condition (p=0.03), and isokinetic 240sek (PLA -7% [-0.14, -0.01], GLU -5.5% [-0.1, 0.009]) on test 3. There was no difference between condition on restitution effect on isometric and isokinetic tests, but a time effect on isokinetic 60sek after 23 hours training session (p=0.02) Conclusion: Ingesting glucose supplement during resistance training decreases protein content of MuRF1 in skeletal muscle

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

Nano liquid chromatography (nanoLC), with columns having an inner diameter (ID) of ≤100 μm, can provide enhanced sensitivity and enable analysis of limited samples. NanoLC has become an established tool in omics research, and is gaining ground in other applications as well. There are several variants and formats of nanoLC columns, including packed columns, monoliths, open tubular columns, and the pillar array format. Most applications are done with packed columns, while e.g. the monolith and open tubular columns are still less established as routine tools. The pillar array format is a new variant with excellent resolution and low backpressure, and has recently been commercialized and used for bio-applications. In this minireview, we summarize and discuss recent research on nanoLC column development and uses, focusing on literature between 2016 and medio 2019.

Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT.A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics.Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of12.5 miles, patients diagnosed at a reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, P.001; ≥250 miles, adjusted odds ratio 0.46; P=.002), all else being equal. The density level of radiation oncologists was not significantly associated with the receipt of RT. Patients who were female, nonwhite, and aged ≥50 years and had comorbidities were less likely to receive RT (P.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at a reporting facility, and resided in Midwest had an increased the likelihood of receipt of RT (P.05).An increased travel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care.

Objectives The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL). Method A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used. Results A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found. Conclusions Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd.

Purpose Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. This study sought to evaluate the association between density of oncologists and travel distance and receipt of adjuvant chemotherapy for colon cancer within 90 days of colectomy. Patients and Methods Patients in the National Cancer Data Base with stage III colon cancer, diagnosed between 2007 and 2010, and age 18 to 80 years were selected. Generalized estimating equation clustering by hospital service area was conducted to examine the association between geographic access and receipt of oncology services, controlling for patient sociodemographic and clinical characteristics. Results Of 34,694 patients in the study cohort, 75.7% received adjuvant chemotherapy within 90 days of colectomy. Compared with travel distance less than 12.5 miles, patients who traveled 50 to 249 miles (odds ratio [OR], 0.87; P = .009) or ≥ 250 miles (OR, 0.36; P < .001) had decreased likelihood of receiving adjuvant chemotherapy. Density level of oncologists was not statistically associated with receipt of adjuvant chemotherapy (low v high density: OR, 0.98; P = .77). When stratifying analyses by insurance status, non–privately insured patients who resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy (OR, 0.85; P = .03). Conclusion Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.

Purpose To determine the characteristics, needs, and concerns of the current radiation oncology workforce, evaluate best practices and opportunities for improving quality and safety, and assess what we can predict about the future workforce. Methods and Materials An online survey was distributed to 35,204 respondents from all segments of the radiation oncology workforce, including radiation oncologists, residents, medical dosimetrists, radiation therapists, medical physicists, nurse practitioners, nurses, physician assistants, and practice managers/administrators. The survey was disseminated by the American Society for Radiation Oncology (ASTRO) together with specialty societies representing other workforce segments. An overview of the methods and global results is presented in this paper. Results A total of 6765 completed surveys were received, a response rate of 19%, and the final analysis included 5257 respondents. Three-quarters of the radiation oncologists, residents, and physicists who responded were male, in contrast to the other segments in which two-thirds or more were female. The majority of respondents (58%) indicated they were hospital-based, whereas 40% practiced in a free-standing/satellite clinic and 2% in another setting. Among the practices represented in the survey, 21.5% were academic, 25.2% were hospital, and 53.3% were private. A perceived oversupply of professionals relative to demand was reported by the physicist, dosimetrist, and radiation therapist segments. An undersupply was perceived by physician's assistants, nurse practitioners, and nurses. The supply of radiation oncologists and residents was considered balanced. Conclusions This survey was unique as it attempted to comprehensively assess the radiation oncology workforce by directly surveying each segment. The results suggest there is potential to improve the diversity of the workforce and optimize the supply of the workforce segments. The survey also provides a benchmark for future studies, as many changes in the healthcare field exert pressure on the workforce.

Purpose The American Society for Radiation Oncology (ASTRO) conducted the 2012 Radiation Oncology Workforce Survey to obtain an up-to-date picture of the workforce, assess its needs and concerns, and identify quality and safety improvement opportunities. The results pertaining to radiation oncologists (ROs) and residents (RORs) are presented here. Methods The ASTRO Workforce Subcommittee, in collaboration with allied radiation oncology professional societies, conducted a survey study in early 2012. An online survey questionnaire was sent to all segments of the radiation oncology workforce. Respondents who were actively working were included in the analysis. This manuscript describes the data for ROs and RORs. Results A total of 3618 ROs and 568 RORs were surveyed. The response rate for both groups was 29%, with 1047 RO and 165 ROR responses. Among ROs, the 2 most common racial groups were white (80%) and Asian (15%), and the male-to-female ratio was 2.85 (74% male). The median age of ROs was 51. ROs averaged 253.4 new patient consults in a year and 22.9 on-treatment patients. More than 86% of ROs reported being satisfied or very satisfied overall with their career. Close to half of ROs reported having burnout feelings. There was a trend toward more frequent burnout feelings with increasing numbers of new patient consults. ROs' top concerns were related to documentation, reimbursement, and patients' health insurance coverage. Ninety-five percent of ROs felt confident when implementing new technology. Fifty-one percent of ROs thought that the supply of ROs was balanced with demand, and 33% perceived an oversupply. Conclusions This study provides a current snapshot of the 2012 radiation oncology physician workforce. There was a predominance of whites and men. Job satisfaction level was high. However a substantial fraction of ROs reported burnout feelings. Perceptions about supply and demand balance were mixed. ROs top concerns reflect areas of attention for the healthcare sector as a whole.

Background:A variety of group activities is promoted for nursing home (NH) residents with dementia with the aim to reduce apathy and to increase engagement and social interaction. Investigating behaviors related to these outcomes could produce insights into how the activities work. The aim of this study was to systematically investigate behaviors seen in people with dementia during group activity with the seal robot Paro, differences in behaviors related to severity of dementia, and to explore changes in behaviors.Methods:Thirty participants from five NHs formed groups of five to six participants at each NH. Group sessions with Paro lasted for 30 minutes twice a week during 12 weeks of intervention. Video recordings were conducted in the second and tenth week. An ethogram, containing 18 accurately defined and described behaviors, mapped the participants’ behaviors. Duration of behaviors, such as “Observing Paro,” “Conversation with Paro on the lap,” “Smile/laughter toward other participants,” were converted to percentage of total session time and analyzed statistically.Results:“Observing Paro” was observed more often in participants with mild to moderate dementia (p = 0.019), while the variable “Observing other things” occurred more in the group of severe dementia (p = 0.042). “Smile/laughter toward other participants” showed an increase (p = 0.011), and “Conversations with Paro on the lap” showed a decrease (p = 0.014) during the intervention period.Conclusions:Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.

Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in home-dwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The project was conducted as a prospective and cluster-randomized multicenter trial with a follow-up. 16 adapted day-care centers recruited respectively 42 (intervention group) and 38 (control group with treatment as usual) home-dwelling PWDs. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3–7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall. Trial registrations ClinicalTrial.gov ; NCT02008630 .

In the era of traditional media, courts typically relied upon geographic constraints, including where a plaintiff lived or worked, to determine the appropriate community in defamation cases. The rise of the Internet has dramatically changed society – easily and immediately linking users across geography while allowing the rapid spread of information through a variety of channels that pose a challenge to the traditional media model centered around editorial judgment and professional ethics. Thanks in part to its global reach, the Internet has allowed users to engage in both business and social relationships around the world. Because of this, a person's need for a good reputation can no longer be confined solely to location. As a result, this article argues that courts must begin to evaluate other factors when determining relevant community in online defamation cases, positing that courts should utilize factors associated with psychological sense of community theory.

Purpose: Anatomical deformations of prostate-bed, rectum, and bladder can compromise the targeting accuracy in post-prostatectomy cancer patients. In this work, the impact of anatomical interventions on the localization data from post-prostatectomy patients who received image-guided IMRT was analyzed. Methods: Patients were localized daily with online kilovoltage cone-beam computed tomography (kV-CBCT). The target and the organs at risk (OARs) positional and volumetric changes were evaluated and couch shifts were applied. For patients with large target or OAR volumetric changes, quantified by either a rectal or bladder wall displacement of > 5 mm on the CBCT sagittal images compared to the planning CT, repeated localization CBCT scans were performed following an interventional procedure. The procedure involves insertion of a catheter to deflate the rectum, evacuation of stools, and/or adjustment of bladder filling. The required shifts were then evaluated, and the IMRT treatment was subsequently delivered after proper patient positioning. The pre- and post-intervention shifts were compared in the lateral [left-right (LR)], longitudinal [superior-inferior (SI)], and vertical [anterior-posterior (AP)] directions. The percentage of shifts larger than 5 mm in all directions was also compared. Clinical target volume to planning target volume (CTV-to-PTV) expansion margins were estimated based on the pre- and post-intervention localization data. Results: Intervention was performed on all patients ( n = 17 ) treated between October 2008 and March 2009. The number of interventions ranged from 2 to 12 with a median number of 5, resulting in a total of 96 pairs of pre- and post-intervention shifts. The mean value ( ∑ ) and standard deviation ( σ ) of the shifts from pre- versus post-intervention data were LR, 0.0 ± 3.0 mm vs 0.5 ± 2.8 mm ; SI, 0.2 ± 3.1 mm vs − 1.0 ± 2.1 mm ; and AP, − 2.6 ± 5.8 mm vs 1.7 ± 3.9 mm . The mean 3D shift distance was 7.0 ± 3.1 mm vs 5.0 ± 2.6 mm . The percentage of pre-intervention shifts larger than 5 mm were 7%, 7%, and 45% in the LR, SI, and AP directions, respectively, compared to 8%, 4%, and 21% for post-intervention. Localization data from pre- and post-intervention procedures suggest that treatments that do not include intervention to correct for rectum/bladder anatomical variations require an additional 3.3 mm CTV-to-PTV margin. Conclusions: Anatomical interventions reduced the localization errors arising from large volume and shape changes in the rectum and/or bladder compared to treatments without interventions.

Purpose: To identify individuals’ health goals and describe their preferences in attaining those goals and to explore associations of type of goals with individual characteristics. Data sources: In a descriptive study, 60 adult patients from primary care clinics completed written questionnaires anonymously. Content analyses and frequencies were used to summarize data. Conclusions: Health promotion interventions could be more effective if they were customized, in part, to individuals’ health goals. There are few evidence-based descriptions of individuals’ own health goals and their preferences in how to pursue them. Participants in this study shared common goals to get in shape, lose weight, and change consumption. Participants preferred to meet initially with practitioners to obtain advice and to connect subsequently by telephone for monitoring. Implications: Participants did want to improve their health. More specific understanding of such goals and preferences is needed to guide future interventions. Findings can inform clinicians and guide researchers in how to design health behavior interventions.

Norge har økt fokus på å styrke helse- og omsorgstjenestenesinnsats ovenfor barn, unge og unge voksne med funksjonsnedsettelser.Tidligere forskning har vist at dyreassistert terapi(DAT) kan bidra til å stimulere rehabilitering. Målet med detteprosjektet var å gi økt kompetanse og kunnskap om DAT vedrehabiliteringsinstitusjon.Tretten pasienter (77% kvinner) i alderen 16 til 23 år fikk DATmed hund tre ganger i uken i fire uker. Pasienter med kroniskutmattelsessyndrom utgjorde 46% av deltakerne, de resterendevar til rehabilitering for traumer og andre typer sykdommer.Data ble samlet inn ved halvstrukturerte intervju av pasienteneog spørreskjema for 13 helsepersonell nært knyttet til pasientene.Nesten alle svarte at hunden hjalp deltakerne til å komme ibedre fysisk form, og 46% av helsepersonell mente at deltakernefikk bedre engasjement i de andre aktivitetene som inngikki rehabiliteringen. Samtlige helsepersonell var svært fornøydmed tiltaket og ville anbefale DAT med hund ved institusjonersom gir tilbud innen kompleks rehabilitering. Institusjonen hari etterkant av prosjektet innlemmet dyreassistert terapi i rehabiliteringav alle sine brukergrupper.

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL).A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used.A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found.Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John WileySons, Ltd.

Supervisor: Kjell Salvanes I denne mastergradsavhandlinga er det gjort rede for utvikling i bustadmønster i Stor-Oslo og Oslo kommune. Gjennom resultat frå segregasjonsindeksar konkluderast det med at Stor-Oslo er moderat segregert, og at det har vore ein svak reduksjon i segregasjonsnivå over tid. For Oslo kommune åleine viser derimot resultata ein svak auke i segregasjon. I samband med ein dynamisk segregasjonsmodell, hevdast det at Oslo kommune kan vere inne i ein segregasjonsgenerert migrasjonsfase. I tillegg til analyse av bustadmønster, vurderast det korleis skulekvalitet og nabolagstrekk påverkar bustadpris. Resultata tyder på at skulekvalitet kapitaliserast i bustadprisar, ved at bustadar lokalisert i skulekretsar med høg skår på nasjonale prøvar krev ein prispremie. Det er også eit sterkt positivt forhold mellom bustadpris og samansetting av landbakgrunn, samt inntekts- og utdanningsnivå i nabolag. nhhmas

Severe (Radiation Therapy Oncology Group [RTOG] grade 3 or greater) esophagitis generally occurs in 15% to 25% of non-small cell lung cancer (NSCLC) patients undergoing concurrent chemotherapy and radiation therapy (CCRT), which may result in treatment breaks that compromise local tumor control and pose a barrier to dose escalation. Here, we report a novel contralateral esophagus-sparing technique (CEST) that uses intensity modulated radiation therapy (IMRT) to reduce the incidence of severe esophagitis.We reviewed consecutive patients with thoracic malignancies undergoing curative CCRT in whom CEST was used. The esophageal wall contralateral (CE) to the tumor was contoured as an avoidance structure, and IMRT was used to guide a rapid dose falloff gradient beyond the target volume in close proximity to the esophagus. Esophagitis was recorded based on the RTOG acute toxicity grading system.We identified 20 consecutive patients treated with CCRT of at least 63 Gy in whom there was gross tumor within 1 cm of the esophagus. The median radiation dose was 70.2 Gy (range, 63-72.15 Gy). In all patients, ≥99% of the planning and internal target volumes was covered by ≥90% and 100% of prescription dose, respectively. Strikingly, no patient experienced grade ≥3 esophagitis (95% confidence limits, 0%-16%) despite the high total doses delivered. The median maximum dose, V45, and V55 of the CE were 60.7 Gy, 2.1 cc, and 0.4 cc, respectively, indicating effective esophagus cross-section sparing by CEST.We report a simple yet effective method to avoid exposing the entire esophagus cross-section to high doses. By using proposed CE dose constraints of V452.5 cc and V550.5 cc, CEST may improve the esophagus toxicity profile in thoracic cancer patients receiving CCRT even at doses above the standard 60- to 63-Gy levels. Prospective testing of CEST is warranted.

This article explores the effect of a group-based exercise program and an educational session on the fear of falling among 89 women with osteoporosis and a history of vertebral fracture. This randomized clinical trial showed that the intervention had a positive and durable effect on the fear of falling. The aim of this study was to evaluate the effect of an intervention on fear of falling in women with osteoporosis and a history of vertebral fracture. The study was a parallel-group randomized clinical trial with a blinded assessor. The participants were 89 community-dwelling elderly women with osteoporosis and a history of vertebral fracture. The intervention group (IT, n = 47) received a 3-month group-based circuit exercise program combined with a 3-h educational session focusing on the reduction of the risk of falls and challenges specific to osteoporosis and vertebral fractures. The control group (CT, n = 42) continued with their usual activities. Clinical outcomes were assessed at baseline, postintervention and 12 months after randomization. This article reports on the secondary outcome Falls Efficacy Scale—International (FES-I) from a previously reported trial. We found a significantly better result for the IT group compared with the CT group, both at 3 months (p = 0.004) and 12 months (p

Oppgåva omhandlar segregeringstendensar i Stavanger. Problemstillinga me har arbeida med er kva som er årsakene til busetjingsmønsteret i Stavanger, og om det finst sosioøkonomiske skilnadar her. Dette har me forsøkt å svare på ved å undersøke fleire faktorar, der hovudfokuset vårt er på segregeringstendensar og bustadmarknad. Me har nytta oss av to datasett for Stavanger med ulik detaljeringsgrad, eit på bydelsnivå og eit på sonenivå. På grunn av at det ligg mykje informasjon i desse datasetta, har me hatt moglegheit til å analysere med omsyn på fleire ulike variablar. I tillegg har me data på bustadmarknaden i Stavanger, som me har knytt opp til dei ulike variablane me har analysert. I analyseringa av datamaterialet har me nytta ulike indeksar for segregering, korrelasjonar og spatial autokorrelasjon. Me har brukt teoriar for segregeringsmekanismar, og modellar frå regionalvitskap for busetjingsmønster i storbyar. Resultata me til slutt kom fram til var at det fantes små veksande segregeringstendensar i Stavanger. Ved å studere bustadmarknaden fann me at det finst skilnadar i bustadprisar i ulike område i Stavanger. Skilnaden i bustadprisar kjem klarast fram på eit aggregert nivå, som bydelsnivå. Det kan dermed tenkjast at busetjingsmønsteret på bydelsnivå kan vere påverka av bustadmarknaden. Det er likevel vanskeleg å trekkje ein konklusjon frå dette, då det truleg kan eksistere ein invers kausalitet her. Me veit ikkje om bustadprisane varierer på grunn av segregering, eller om segregeringstendensane kjem som følgje av at bustadprisane varierer. Når me studerte sonenivå var det her mindre variasjon i bustadprisar, og busetjingsmønsteret på dette disaggregerte nivået kan truleg betre forklarast av andre årsaker som kan skape segregeringstendensar. Det finst sosioøkonomiske skilnadar i Stavanger, men desse er ikkje utprega store.

Anatomical deformations of prostate-bed, rectum, and bladder can compromise the targeting accuracy in post-prostatectomy cancer patients. In this work, the impact of anatomical interventions on the localization data from post-prostatectomy patients who received image-guided IMRT was analyzed.Patients were localized daily with online kilovoltage cone-beam computed tomography (kV-CBCT). The target and the organs at risk (OARs) positional and volumetric changes were evaluated and couch shifts were applied. For patients with large target or OAR volumetric changes, quantified by either a rectal or bladder wall displacement of5 mm on the CBCT sagittal images compared to the planning CT, repeated localization CBCT scans were performed following an interventional procedure. The procedure involves insertion of a catheter to deflate the rectum, evacuation of stools, and/or adjustment of bladder filling. The required shifts were then evaluated, and the IMRT treatment was subsequently delivered after proper patient positioning. The pre- and post-intervention shifts were compared in the lateral [left-right (LR)], longitudinal [superior-inferior (SI)], and vertical [anterior-posterior (AP)] directions. The percentage of shifts larger than 5 mm in all directions was also compared. Clinical target volume to planning target volume (CTV-to-PTV) expansion margins were estimated based on the pre- and post-intervention localization data.Intervention was performed on all patients (n=17) treated between October 2008 and March 2009. The number of interventions ranged from 2 to 12 with a median number of 5, resulting in a total of 96 pairs of pre- and post-intervention shifts. The mean value (sigma) and standard deviation (sigma) of the shifts from pre- versus post-intervention data were LR, 0.0 +/- 3.0 mm vs. 0.5 +/- 2.8 mm; SI, 0.2 +/- 3.1 mm vs. -1.0 +/- 2.1 mm; and AP, -2.6 +/- 5.8 mm vs. 1.7 +/- 3.9 mm. The mean 3D shift distance was 7.0 +/- 3.1 mm vs. 5.0 +/- 2.6 mm. The percentage of pre-intervention shifts larger than 5 mm were 7%, 7%, and 45% in the LR, SI, and AP directions, respectively, compared to 8%, 4%, and 21% for post-intervention. Localization data from pre- and post-intervention procedures suggest that treatments that do not include intervention to correct for rectum/bladder anatomical variations require an additional 3.3 mm CTV-to-PTV margin.Anatomical interventions reduced the localization errors arising from large volume and shape changes in the rectum and/or bladder compared to treatments without interventions.

To assess daily variations in delivered doses in postprostatectomy patients, using kilovoltage cone-beam CT (CBCT) datasets acquired before and after interventions to correct for observed distortions in volume/shape of rectum and bladder.Seventeen consecutive patients treated with intensity-modulated radiotherapy to the prostate bed were studied. For patients with large anatomical variations, quantified by either a rectal wall displacement of5 mm or bladder volume change of50% on the CBCT compared with the planning CT, an intervention was performed to adjust the rectum and/or bladder filling. Cumulative doses over the pre- and post-intervention fractions were calculated by tracking the position of the planning CT voxels on different CBCTs using a deformable surface-mapping algorithm. Dose and displacements vectors were projected on two-dimensional maps, the minimal dose received by the highest 95% of the planing target volume (PTV D95) and the highest 10% of the rectum volume (D10) as well as the bladder volume receiving2 Gy (V2) were evaluated.Of 544 fractions, 96 required intervention. Median (range) number of interventions per patient was 5 (2-12). Compared with the planning values, the mean (SD) pre- vs. postintervention value for PTV D95 was -2% (2%) vs. -1% (2%) (p0.12), for rectum D10 was -1% (4%) vs. +1% (4%) (p0.24), and for bladder V2 was +6% vs. +20% (p0.84).Interventions to reduce treatment volume deformations due to bladder and rectum fillings are not necessary when patients receive daily accurate CBCT localization, and the frequency of those potential interventions is low. However, for hypofractionated treatments, the relative frequency can significantly increase, and interventions can become more dosimetrically beneficial.

To evaluate the toxicity of daily gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor, with concurrent chemoradiation (CRT) in patients with locally advanced pancreatic adenocarcinoma and prospectively evaluate plasma k-ras as a potential marker of response to gefitinib and CRT.Eleven of 12 eligible patients enrolled received a 7-day induction of gefitinib (250 mg PO) followed by daily gefitinib with concurrent CRT. Patients received 50.4 Gy/28 fractions of external beam radiation with weekly paclitaxel (40 mg/m IV) followed by maintenance on gefitinib. Plasma k-ras codon 12 mutations were detected using a two-stage restriction fragment length polymorphism-polymerase chain reaction assay on patients' plasma both before and after therapy. Mutations were confirmed by direct sequencing.Common adverse events included grade 1 skin rash (63%), grade 1 to 2 gastrointestinal symptoms including anorexia, nausea, vomiting, and diarrhea occurred in 63% of patients, grade 3 nausea occurred in 45% of patients. Three patients did not complete therapy, only one was possibly associated with study drug. K-ras mutations were detected in the pre-gefitinib plasma of 5/11 patients and in the matched tumor tissue of 3/4 patients. In patients where k-ras mutations were undetectable post-treatment, survival times were favorable.Combination of daily gefitinib with concurrent CRT in this locally advanced pancreatic cancer population was reasonably tolerated. Rapid changes in serum k-ras may provide critical information as to the efficacy of a novel agent and assist in tailoring treatment for cancers of the pancreas.

Purpose Epidermal growth factor receptor (EGFR) gene copy number detected by fluorescent in situ hybridization (FISH) has proven to be useful for selection of non–small-cell lung cancer (NSCLC) patients for treatment with EGFR tyrosine kinase inhibitors. Here, we evaluate EGFR FISH as a predictive marker in NSCLC patients receiving the EGFR monoclonal antibody inhibitor cetuximab plus chemotherapy. Patients and Methods Two hundred twenty-nine chemotherapy-naive patients with advanced-stage NSCLC were enrolled onto a phase II selection trial evaluating sequential or concurrent chemotherapy (paclitaxel plus carboplatin) with cetuximab. Results EGFR FISH was assessable in 76 patients with available tumor tissue and classified as positive (four or more gene copies per cell in ≥ 40% of the cells or gene amplification) in 59.2%. Response (complete response/partial response) was numerically higher in FISH-positive (45%) versus FISH-negative (26%) patients (P = .14), whereas disease control rate (complete response/partial response plus stable disease) was statistically superior (81% v 55%, respectively; P = .02). Patients with FISH-positive tumors had a median progression-free survival time of 6 months compared with 3 months for FISH-negative patients (P = .0008). Median survival time was 15 months for the FISH-positive group compared with 7 months for patients who were FISH negative. (P = .04). Furthermore, survival favored FISH-positive patients receiving concurrent therapy. Conclusion These results are the first to suggest that EGFR FISH is a predictive factor for selection of NSCLC patients for cetuximab plus chemotherapy. Prospective validation of these findings is warranted.

Purpose: To describe the histologic and volumetric changes in normal liver tissue after stereotactic body radiotherapy (SBRT) for liver metastases. Methods and Materials: Pre- and post-SBRT imaging studies were analyzed to evaluate the effect of SBRT on normal liver volume (NLV) in 15 patients treated in a prospective clinical trial. Two other patients underwent exploratory surgery after SBRT and histologic analyses of the irradiated liver were performed to characterize the pathologic effects of SBRT. Results: In the 15 patients studied quantitatively, the total NLV had decreased transiently at 2-3 months after SBRT and then began to regenerate at 3-8 months after SBRT. The median NLV reduction at the maximal observed effect was 315 cm{sup 3} (range, 125-600) or 19% (range, 13-33%). Among the several dosimetric parameters evaluated, the strongest linear correlation was noted for the NLV percentage receiving 30 Gy as a predictor of maximal NLV reduction (r{sup 2} = 0.72). The histologic changes observed 2 and 8 months after SBRT demonstrated distinct zones of tissue injury consistent with localized veno-occlusive disease. Conclusion: The well-demarcated focal parenchymal changes after liver SBRT (demonstrated both radiographically and histologically) within the high-dose zone are consistent with a threshold dose-induced set of phenomena. Inmore » contrast, the more global effect of NLV reduction, which is roughly proportional to whole organ dose parameters, resembles more closely an effect determined from radiobiologically parallel architecture. These observations suggest that modeling of normal tissue effects after liver SBRT might require different governing equations for different classes of effects.« less

We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition, to examine the associations between prediagnostic serum concentrations of C-peptide, insulin-like growth factor binding protein (IGFBP)-l and IGFBP-2, and endometrial cancer risk. Among pre- and postmenopausal women, who were not currently using exogenous hormones, 286 women developed incident endometrial cancer during an average 5.1 years follow-up. Using risk set sampling, 555 matched control subjects were selected. In conditional logistic regression models adjusted for matching factors only, endometrial cancer risk increased with increasing serum levels of C-peptide (relative risks (RR) for the top vs. bottom quartile = 2.13 [95% confidence interval (CI) 1.33-3.41], p(trend) = 0.001, and decreasing serum levels of IGFBP-2 (RR for the lop vs. bottom quartile = 0.56 [95% CI 0.35-0.90], p(trend) = 0.03, but was not significantly associated with IGFBP-1 levels (RR for the top vs. bottom quartile = 0.76 [95% CI 0.47-1.21], p(trend) = 0.25). In BMI-adjusted models, only the C-peptide association remained marginally statistically significant (RR for the top vs. bottom quartile = 1.56 [95% CI 0.94-2.571, p(trend) = 0.05 for C-peptide; 0.84 [95% CI 0.50-1.40], p(trend) = 0.74 for IGFBP-2; and 1.08 [95% CI 0.65-1.781, p(trend) = 0.86 for IGFBP-1 levels). These associations were stronger among nonfasting women (