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Information and communication technologies (ICTs) have been shown to facilitate LGBTQ+ emerging adult development as well as international migration. Nonetheless, few studies have examined pre- and post-migration ICT use among LGBTQ+ emerging adult migrants. To fill this knowledge gap, we conducted online interviews with 37 LGBTQ+ individuals (ages 20–25) who migrated from various countries to different U.S. states. Constructivist grounded theory was used to identify four themes: In and out: Balancing identity exploration with identity concealment when using ICTs in the country of origin; relying on ICTs to prepare for migration to the United States; using ICTs to find housing, work, and friends in the United States; and drawbacks of using ICTs in the United States. ICTs facilitated identity development and eased integration but exposed participants to harassment and scams. Findings indicate that closely investigating ICT use can enhance developmental and migration theories, improve research, and inform programs and services.

Embodiment refers to understanding the body as the object and subject of culture, a process that allows an understanding of political, cultural, social, and emotional processes in the assemblage of a particular identity. We describe a qualitative-narrative study utilizing focus groups and interviews in three Mexican cities with 75 LGBTQ+ youth to understand the effects of discrimination and how this impacts subjectivity through embodied affection. Through axial and line-by-line analysis, we describe the process of embodiment through four dimensions: violence, emotions, agency, and materiality. Violence operates as the sediment for LGBTQ+ youth's subjective, social, and political life, and paves the way for particular emotions, such as guilt, shame, fear, sadness, and pain, that directly relates to material aspects such as gender expression and body presentation, beauty standards and a discourse around perversion and promiscuity. Finally, the combination of emotions and materiality prove relevant for certain expressions of agency and resilience.

Centroid moment tensor (CMT) parameters of earthquakes are routinely estimated to gain information on structures and regional tectonics. However, for small earthquakes (M

A hybrid quality control (QC) program was developed that integrates automated and conventional Linac QC, realizing the benefits of both automated and conventional QC, increasing efficiency and maintaining independent measurement methods. Failure mode and effects analysis (FMEA) was then applied in order to validate the program prior to clinical implementation. The hybrid QC program consists of automated QC with machine performance check and DailyQA3 array on the TrueBeam Linac, and Delta4 volumetric modulated arc therapy (VMAT) standard plan measurements, alongside conventional monthly QC at a reduced frequency. The FMEA followed the method outlined in TG-100. Process maps were created for each treatment type at our center: VMAT, stereotactic body radiotherapy (SBRT), conformal, and palliative. Possible failure modes were established by evaluating each stage in the process map. The FMEA followed semiquantitative methods, using data from our QC records from eight Linacs over 3 years for the occurrence estimates, and simulation of failure modes in the treatment planning system, with scoring surveys for severity and detectability. The risk priority number (RPN) was calculated from the product of the occurrence, severity, and detectability scores and then normalized to the maximum and ranked to determine the most critical failure modes. The highest normalized RPN values (100, 90) were found to be for MLC position dynamic for both VMAT and SBRT treatments. The next highest score was 35 for beam position for SBRT, and the majority of scores were less than 20. Overall, these RPN scores for the hybrid Linac QC program indicated that it would be acceptable, but the high RPN score associated with the dynamic MLC failure mode indicates that it would be valuable to perform more rigorous testing of the MLC. The FMEA proved to be a useful tool in validating hybrid QC.

Background: Heterosexually identified men who have sex with men (H-MSM) are distinct from other heterosexual men and from gay, bisexual, and other sexual minority men. Specifically, H-MSM experience discordance between their sexual identity (i.e., heterosexual) and behaviours (i.e., sexual encounters with other men). This sexual identity-behaviour discordance can create barriers to obtaining healthcare and social support. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. The aim of the present study is to provide an overview of research on H-MSM.Methods: A scoping review will be conducted to identify and describe the identity development, attraction, and behaviour of H-MSM. This scoping review will also identify and describe current trends related to the recruitment of H-MSM and recommended directions for future research. Searches will be conducted in Academic Search Complete, APA PsychInfo, CINAHL Plus with Full Text, Education Research Complete, Gender Studies Database, GenderWatch, Health Source: Nursing/Academic Edition, LGBTQ+ Source, MEDLINE, Psychology and Behavioral Sciences Collection, SocINDEX with Full Text, Sociological Collection, Social Work Abstracts, ProQuest Dissertations and Theses, Google, Web of Science, and ResearchGate. Primary research studies published in peer-reviewed journals will be included. Dissertations and theses that include primary research on H-MSM will also be included. Reference lists, experts in the field, preprint servers, and relevant conferences will also be consulted for extant and in-progress literature. Two reviewers will independently pilot the data extraction form and conduct the title and abstract screening, with consultation from a research librarian. Seven reviewers will then conduct the full-text article screening. Thematic content analysis will guide the review; through independent review and reviewer meetings, themes and subthemes will be identified and reported from the extracted literature.Discussion: This is the first known knowledge synthesis on H-MSM; it seeks to better understand sexual identity-behaviour discordance amongst cisgender men. We anticipate that a theoretical framework of H-MSM’s sexuality, internal processes, and behaviours will be constructed from this review. Alongside implications for further research with H-MSM, this review may be relevant to sexually transmitted infection public health, and to clinicians working in the field of male sexuality.Scoping review registration: Submitted to Open Science Framework

Purpose Paclitaxel is associated with hypersensitivity reactions (HSRs). Intravenous premedication regimens have been devised to decrease the incidence and severity of HSRs. At our institution oral histamine 1 receptor antagonists (H1RA) and histamine 2 receptor antagonists (H2RA) were adopted as standard. Standardizations were implemented for consistent premedication use in all disease states. The purpose of this retrospective study was to compare the incidence and severity of HSRs before and after standardization. Methods Patients who received paclitaxel from 20 April 2018 to 8 December 2020 having an HSR were included in analysis. An infusion was flagged for review if a rescue medication was administered after the start of the paclitaxel infusion. The incidences of all HSR prior to and post-standardization were compared. A subgroup analysis of patients receiving paclitaxel for the first and second time was performed. Results There were 3499infusions in the pre-standardization group and 1159infusions in the post-standardization group. After review, 100 HSRs pre-standardization and 38 HSRs post-standardization were confirmed reactions. The rate of overall HSRs was 2.9% in the pre-standardization group and 3.3% in the post-standardization group ( p = 0.48). HSRs, during the first and second doses of paclitaxel, occurred in 10.2% of the pre-standardization and 8.5% of the post-standardization group ( p = 0.55). Conclusions This retrospective interventional study demonstrated that same-day intravenous dexamethasone, oral H1RA, and oral H2RA are safe premedication regimens for paclitaxel. No change in the severity of reactions was seen. Overall, better adherence to premedication administration was seen post-standardization.

Highlights • Seroma was not associated with patient-reported breast appearance change after breast radiotherapy. • Haematoma and smoking were significant risk factors for patient-reported breast appearance change. • Seroma prevalence in our study was lower than previous reports., Background Seroma describes a collection of serous fluid within a cavity, occurring following surgery. Seroma is associated with normal tissue effects (NTE) following breast radiotherapy, as reported by clinicians and on photographs. This study investigates the association between seroma and the NTE breast appearance change collected using patient-reported outcome measures (PROMs) in IMPORT HIGH, as well as investigating the association between breast appearance change and patient/tumour/treatment factors. Methods Case–control methodology was used for seroma analysis within IMPORT HIGH. Cases were patients reporting moderate/marked breast appearance change and controls reported none/mild changes at year-3. One control was selected at random for each case. Seromas were graded as not visible/subtle or visible/highly visible on CT radiotherapy planning scans. Logistic regression tested associations, adjusting for patient/tumour/treatment factors. Results 1078/1149 patients consented to PROMs, of whom 836 (78%) reported whether they had 3-year breast appearance change; 231 cases and 231 controls were identified. 304/462 (66%) patients received chemotherapy. Seroma prevalence was 20% (41/202) in cases and 16% (32/205) in controls, and less frequent in patients receiving adjuvant chemotherapy [10% (24/246) compared with 29% (40/138) without]. Visible seroma was not significantly associated with breast appearance change [OR 1.38 (95%CI 0.83–2.29), p = 0.219]. Larger tumour size, haematoma, current smoking and body image concerns at baseline were independent risk factors. Conclusions Seroma was not associated with patient-reported breast appearance change, but haematoma and smoking were significant risk factors. Lack of association may be related to lower prevalence of seroma compared with previous reports, perhaps reflecting patients receiving adjuvant chemotherapy in whom seroma resolves prior to radiotherapy.

BACKGROUND Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. OBJECTIVE The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. METHODS SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. RESULTS Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. CONCLUSIONS AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13462

The aim of this article is to propose meaningful guidance covering the technical and safety issues involved when designing or conducting radiotherapy clinical trials that use MRI for treatment planning. The complexity of imaging requirements will depend on the trial aims, design and MRI methods used. The use of MRI within the RT pathway is becoming more prevalent and clinically appropriate as access to MRI increases, treatment planning systems become more versatile and potential indications for MRI-planning in RT are documented. Novel MRI-planning opportunities are often initiated and validated within clinical trials. The guidance in this document is intended to assist researchers designing RT clinical trials involving MRI, so that they may provide sufficient information about the appropriate methods to be used for image acquisition, post-processing and quality assurance such that participating sites complete MRI to consistent standards. It has been produced in collaboration with the National Radiotherapy Trials Quality Assurance Group (RTTQA). As the use of MRI in RT is developed, it is highly recommended for researchers writing clinical trial protocols to include imaging guidance as part of their clinical trial documentation covering the trial-specific requirements for MRI procedures. Many of the considerations and recommendations in this guidance may well apply to MR-guided treatment machines, where clinical trials will be crucial. Similarly, many of these recommendations will apply to the general use of MRI in RT, outside of clinical trials. This document contains a large number of recommendations, not all of which will be relevant to any particular trial. Designers of RT clinical trials must therefore take this into account. They must also use their own judgement as to the appropriate compromise between accessibility of the trial and its technical rigour.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Purpose: The purpose of the study is to investigate and establish the Critical Project Management Success Factors (CPMSF) for the sustainable social (public) housing estates’ delivery/provision in Nigeria. The current housing estate deficit faced in the country is credited to poor and inadequate housing delivery and provision by various agencies. Method/design: Documentary analysis of data collection was used in the study which involved an extensive and investigative theoretical review of online and visual document resources, followed by an interpretative identification of categories and limits of various materials and information considered vital to the phenomenon in the study. The documents were analysed with a content analysis approach under four criteria of how: authentic; credible; representative; and meaningful. Findings/results: The study reveals that 22 Critical Project Management Success Factors (CPMSF) are essential for the achievement of sustainable social (public) housing estates’ delivery/provision in Nigeria. These relate to: the project managers’ performance; the organisation that owns the development project; the characteristics of the team members; and the external project environment. At the same time, the study reveals that these are social, economic, and environmental factors that are associated with the triple objectives of sustainable development. Originality/value: This study reflection aims to resolve or reduce to a minimum the acknowledged housing estate delivery and provision inadequacy problems in the country, and by exploring this phenomenon, best practise project management techniques will be understood and used to provide sustainable social (public) housing estate units for the Nigerian populace.

PurposeThe purpose of this paper is to define and quantify the term robustness within the context of a Private Finance Initiative (PFI) project environment from the perspective of the Granting Authority. The paper is conceptual, based on conceptual generalisations.Design/methodology/approachThe paper considers the theory of systems thinking within PFI procurement. This is further integrated with the concept of robustness and resilience used extensively in the ecology discipline. Combining the two, this paper presents a mathematical approach of quantifying robustness in PFI projects.FindingsAn analytical model is used to support the mathematical analysis to quantify and define robustness.Research limitations/implicationsThe quantifying of robustness is based on the principal assumptions presented in the paper. The principal assumptions provide an ideal situation which is necessary to pursue and develop the proposed approach to quantify robustness. Changes to the assumptions may affect the generalisability of the approach.Originality/valueThe paper provides a greater definition to robustness within PFI projects and the possibility of quantifying robustness to better monitor and manage the characteristic.

The necessity of funds for investment in capital intensive public projects has pushed public agencies to search for new procurement alternatives. Thus, in the early 1980s, the idea of private finance initiative (PFI) as a method of financing large-scale, capital intensive projects emerged in Australia. The method is aimed at resolving the shortage of public funds for major investments through the funding capability of private entities. Later, the method was widely used by other governments with the same name or different names such as BOT (build-operate-transfer) in the countries having different legal structures. This paper describes the mechanism of PFI used by the UK Government and evaluates three case studies in achieving the essential characteristics of adequate risk transfer and value for money to the taxpayer. Santrauka Fondų poreikis investuoti į intensyvaus kapitalo viešuosius projektus pastūmėjo viešąsias įstaigas ieškoti naujų turto įsigijimo alternatyvų. Dar praeito amžiaus devintajame dešimtmetyje Australijoje atsirado būdas finansuoti didžiulius, daug kapitalo reikalaujančius projektus – privataus finansavimo iniciatyvos idėja. Šiuo metodu siekiama išspręsti viešųjų lėšų trūkumo problemą, daugeliu atvejų skiriant lėšas iš privačių organizacijų fondų. Vėliau minėtąjį metodą plačiai taikė kitų šalių su skirtingomis teisinėmis struktūromis vyriausybės. Straipsnyje paaiškinamas privataus finansavimo iniciatyvos mechanizmas, kurį taiko Jungtinės Karalystės vyriausybė ir įvertinami trijų atliktų tyrimų rezultatai, pateikiamos pagrindinės charakteristikos. Резюме Потребность в фондах для инвестирования капитала в общественные проекты привела к тому, что общественные учреждения вынуждены искать новые альтернативы для приобретения имущества. Еще в 80-е годы прошлого столетия в Австралии родилась идея, как финансировать глобальные проекты, требующие большого количества средств, – так называемая идея частного финансирования. Этот способ позволяет решить проблему нехватки общественных средств, при этом средства выделяются из фондов частных организаций. Позже упомянутый способ широко использовался правительствами разных стран с разными правовыми структурами. В статье объясняется механизм инициативы частного финансирования. Данный механизм используется правительством Великобритании, в нем сочетаются результаты трех проведенных исследований, характеристики которых представлены в статье.

Background: ATM (ataxia telangiectasia mutated protein) is a serine-threonine kinase that is a key mediator of the DNA damage response elicited by double strand breaks. AZD0156 is a potent, selective inhibitor of ATM. Preclinical data suggest a synergistic effect of AZD0156 when combined with DNA damage targeting agents, including olaparib. Materials and Methods: This is an international, modular phase I study to assess the safety, tolerability, pharmacokinetics, and preliminary efficacy of escalating doses of AZD0156 in combination with either cytotoxic chemotherapy or novel anticancer agents in patients with advanced malignancies. Here we report the results of Module 1, an evaluation of AZD0156 with olaparib. Patients with solid tumors and PS 0 or 1 were recruited in cohorts of 3 to 6 evaluable patients. Module 2 will be a combination with irinotecan. Results: 46 patients have been recruited in 8 cohorts combining AZD0156 with olaparib (Table 1). The terminal half-life of AZD0156 was approximately 9-12 hours and dose/exposure proportionality was observed. No significant PK interactions were observed with olaparib. Minor toxicities included nausea, vomiting, and anemia in about 40% of patients in all cohorts. Grade 3 and 4 hematologic toxicities were observed in cohort 7 (AZD0156 120mg po bd with olaparib 200mg po bd), and this dose level was considered intolerable. At doses of AZD0156 of 60mg bd, plasma concentrations of AZD0156 were consistent with efficacy in gastric cancer cell cultures. Further dosing schedules are being explored. There have been two confirmed partial responses (RECIST): one in a patient whose tumor harboured germline BRCA2 mutations (Cohort 2), and one in a patient whose tumor had unknown tumor genetics but no significant family history (Cohort 4a). One patient with somatic BRCA2 deletion has had stable disease for 18 months (Cohort 1). Conclusions: Hematologic toxicity, consistent with the mode of action, appears to be the treatment-limiting toxicity for AZD0156 in combination with olaparib. AZD0156 can be given at doses and schedules that achieve exposures consistent with in vitro efficacy. Continued exploration of AZD0156 in combination with olaparib and other agents in solid malignancies is a promising area for further research. Cohort / Evaluable patientsDose/Schedule AZD0156Dose/Schedule olaparibComment1 / 62mg od for 3 days out of 7100mg bd continuouslyWell tolerated2 / 58mg od for 3 days out of 7100mg bd continuouslyWell tolerated3 / 630mg od for 3 days out of 7100mg bd continuouslyWell tolerated4a / 630mg bd for 3 days out of 7100mg bd continuouslyWell tolerated4b / 615mg bd for 3 days out of 7200mg bd continuouslyWell tolerated5 / 430mg bd for 3 days out of 7200mg bd continuouslyWell tolerated6a / 460mg bd for 3 days out of 7200mg bd continuouslyWell tolerated. PK indicated AZD0156 exposures are proportional to doses and reach IC90 defined in gastric ca cell line6b / 430mg bd for 3 days out of 7300mg bd continuously1 patient experienced Grade 2 neutropenia & thrombocytopenia7 / 4120mg bd for 3 days out of 7200mg bd continuously1 patient: Grade 2 neutropenia & thrombocytopenia; 1 patient: Grade 3 anaemia, Grade 2 thrombocytopenia and Grade 4 neutropeniaAE’s occurred during Cycle 1 or 2; were not Dose Limiting Toxicities as defined in the protocol, but considered to be non-tolerated by the Safety Review Committee8 / 260mg bd for 3 days out of 7300mg bd continuouslyPotential candidate for efficacy evaluation Citation Format: Wassim Abida, Yung J. Bang, Louise Carter, Analía Azaro, Matthew Krebs, Seock-Ah Im, Yingxue Chen, Núria Buil-Bruna, Yan Li, David Eaton, Christine Stephens, Graham Ross, Martin Pass, Jordi Rodon, Emma Dean. Phase I modular study of AZD0156, a first-in-class oral selective inhibitor of ataxia telangiectasia mutated protein kinase (ATM), in combination with olaparib (AToM Study, Module 1) [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A094.

Purpose – This paper seeks to introduce an evolved hybrid genetic algorithm and neural network (GNN) model. The model is developed to predict contractor performance given the current attributes in a process to pre‐qualify the most appropriate contractor. The predicted performance is used to pre‐qualify the contractors.Design/methodology/approach – Hypothetical and real‐life case studies from projects executed in the Gaza Strip and West Bank were collected through structured questionnaires. The evaluation of the contractor's attributes and the corresponding actual performance of the contractor in terms of time, cost, and quality overrun (OR) were collected. The weighted contractor's attributes were used as inputs to the GNN model. The corresponding time, cost, and quality ORs for the same cases were fed as outputs to the GNN model in a supervised learning back propagation neural network (NN). (The adopted training and testing process to develop a trained model is presented.) The training process, including...

Aim To identify factors that may prevent or delay patients referred for consideration of phase I studies from commencing such a study. Methods A retrospective audit of phase I study referrals for the period 1st March to 31st August 2005 to the Drug Development Unit was performed. All reasons that led to either delay or recruitment failure were documented and analysed. Results Data from 176 patients (105M/71F) were analysed. Median age at referral was 59 years and median performance status (PS) was 1. Of these, 56 (32%) were successfully recruited in a phase I trial. The median time from trial allocation to commencement of treatment was 4.8 weeks. Poor or deteriorating PS was the reason for delay or recruitment failure in 43 (35%) of non-recruited patients. Conclusions Poor or deteriorating PS was the most common factor limiting accrual to phase I trials. Better patients’ selection on this basis might improve recruitment rates.

Objectives. This study aims at analyzing the clinico-demographic features that influence the recruitment of gynecological cancer (GC) patients to phase I trials. The possible clinical benefit to patients resulting from the participation in these trials has been also investigated. Methods. We performed a retrospective analysis of GC patients referred to the Phase I Unit of the Royal Marsden Hospital in Sutton (Surrey, UK), over 2 years. Results. Overall 68 GC patients were referred, and subsequently 32 (47.1%) enrolled. The percentage of patients enrolled increased as the distance to travel between the patient's residence and the hospital shortened (8.3% through 47.8% to 60.8%, for travel time >2, 1–2 or ≤1 h, respectively; p =0.008). Better performance status (PS) was found to be associated with higher enrollment rate with percentages increasing from 0 through 51.2 to 58.8 in cases with PS≥2, PS=1, PS=0, respectively ( p =0.015). Among the biochemical parameters, only hepatobiliary dysfunction was found to be associated with lower enrollment ( p =0.012). Minimal response/disease stabilization was observed in 11 patients (34.4%). An increased median survival following the first visit was observed in patients enrolled compared to those not enrolled (8 versus 4 months, respectively, p =0.0055). In the multivariate analysis, only PS and enrollment in trials retained an independent prognostic role ( p =0.031 and p =0.040, respectively). Conclusions. This study, suggesting liver function and PS as important factors influencing the recruitment of GC patients to phase I trials could guide referral of patients to phase I Units. Moreover, the practical limitations imposed by long distance travel, together with the potential clinical benefit due to the participation to these trials, should encourage more investigators to develop phase I units in major cancer centers.