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BACKGROUND: The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS: We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS: Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION: The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.

Excessive and persistent use of plastic bags has caused severe environmental impact in many developing countries and the significance of biodegradable plastic bags as an alternative solution is uncertain. Bandar Baru Bangi, the second township in the Selangor state in Peninsular Malaysia, has also been plagued with problems of plastic bag use where plastic bags cover 56% of the household waste. Selangor has introduced a plastic bag fee of MYR 0.20 to shoppers who requested for it, albeit the effectiveness of such policy in changing consumer behavior is still unknown. The objectives of the study were to assess consumers’ plastic bags consumption behavior in Bandar Baru Bangi, and determine factors influencing their willingness to pay (WTP) for an increase fee in using biodegradable plastic bags. A questionnaire survey incorporating Contingent Valuation Method was conducted to elicit the consumers’ WTP. The results indicate that majority of the respondents (83%) requested one to three plastic bags per shopping trip. They moderately agreed that their tendency for plastic bag use was influenced by other consumers in the surrounding and highly agreed on the impact of environmental campaigns. The WTP for biodegradable plastic bags was estimated at MYR 0.43 which was influenced by their age and education level. The findings suggest there is a need to revisit the effectiveness of the policy and revise proper intervention measures to reduce plastic bag use.

All organizations are impacted by sustainability, both positively and negatively. It is therefore important to assess the sustainability of any human activity, product, or development. Life Cycle Sustainability Assessment (LCSA) is one of the most effective methods for assessing sustainability. The significance of this study is that it highlights significant and key ideas in the subject of LCSA, including research commonality, research trends, model shortcomings, existing appropriate methods, and research gaps using a systematic review of the literature and bibliometric analysis. The developing tendency of reviewing suggests that while sustainability issues are a severe problem for all countries, they will continue to rule social, economic, and environmental issues in the years to come. There are still a lot of uncharted territories. The study found that energy was the most popular topic among related areas of LCSA application. According to the research findings, it was also suggested that LCSA could be improved in future research in the following areas: the development of impact categories to enable study comparison, the definition of coherent system boundaries, the development of impact assessment methodologies, the development of trustworthy databases to enable the evaluation of economic and social perspectives, the development of tools for performing uncertainty analysis and communication strategies. To advance technique development and comprehend the interplay between environmental, economic, and social aspects, more case studies are required. It is envisaged that the development and application of LCSA will contribute to the accomplishment of Sustainable Development Goals across a range of international locations, businesses, and goods.

Wildlife especially large mammals such as elephants are an important part of an ecosystem providing various ecological functions and services, although they are often involved in human-wildlife conflict. The National Elephant Conservation Center (NECC) in the Pahang state of Peninsular Malaysia was established to ensure that the survival of the Asian Elephant ( Elephas maximus ) in Peninsular Malaysia through direct management, as well as educational and public awareness activities. However, no entrance fee has been imposed since the establishment of the center in 1989 (32 years). This study aimed to determine public willingness to pay for an entrance fee in the NECC. By using the open-ended contingent valuation method (CVM), the mean public willingness to pay for an entrance fee in the NECC during the non-peak season amounted to RM4.65/person/visit whereas it was RM7.09/person/visit during the peak season. The study would serve as a reference for entrance fee implementation for a conservation center as a form of financial aid to sustain the center as well as highlight the importance of public engagement in elephant conservation.

Growing concerns of climate crisis mitigation in Malaysia over the decades have created pressure for public listed companies and small and medium enterprises in the country to adopt a different approach in their business operations. Green financing schemes such as the Environmental,Social and Governance (ESG) indicator,the FTSE4Good index by the regulatory body Bursa Malaysia for public listed companies and the Green Technology Financing Scheme stemming from the National Green Technology Policy by the Malaysian Green Technology and Climate Change Centre,address the need to improve operations sustainably through financing. Based on interviews with government agencies and public listed companies,this paper presents the effectiveness of the guidelines and schemes in place from their perspectives. The value drivers,challenges and impact from adhering to the FTSE4Good index were discovered. Findings found that the government is a central player in ensuring the initiatives' effectiveness. Although there have been improvements over the years in the industry since its introduction,barriers are still lingering that may hamper the extent of the initiatives' effectiveness. Suggestions are made as a feedback mechanism for improved green financing towards Malaysia's aspiration on becoming a high-income nation by 2025 and in support of the Sustainable Development Goal 9: Industrial innovation and infrastructure. To realise that aspiration,every player in the industry plays a critical role in greener operations,including the small and medium enterprises.

PurposeStudents applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated.Methods and materialsAn anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content.ResultsThe survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank-sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43).ConclusionsBased on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results support further development of structured didactic curricula for the radiation oncology clerkship.

Background: Stereotactic radiosurgery (SRS) is a current therapeutic option for treatment of arteriovenous malformations (AVMs) located in deep or eloquent brain regions. Obliteration usually occurs in a delayed fashion, with an expected latency of 3–5 years. Here, we assess how AVM flow correlates with volume before and after SRS treatment. Methods: Patients with supratentorial AVM treated with SRS at our institution between 2012–2022 were retrospectively reviewed. Patients were included if Quantitative Magnetic Resonance Angiography (QMRA) study was performed at baseline and at least at the first follow-up. Correlation between AVM flow and volume before and after treatment was evaluated. AVM flow and volume were additionally assessed for obliteration using the non-parametric receiver operating characteristic (ROC) curve. Results: Twelve patients with radiologic follow-up imaging were included. Eight patients presented AVM rupture, one of which occurred after radiosurgical treatment. Three patients underwent embolization prior SRS. Mean AVM initial volume was 3.8 cc (0.1–12.4 cc), mean initial flow 174 ml/min (11–604 ml/min), both variables showed progressive reduction at follow-up (range 3–57 months); and flow decreased with volume reduction (p < 0.001). Area under the ROC was 0.914 for both AVM flow and volume with obliteration (p = 0.019). Conclusions: AVM flow significantly decreased after SRS treatment, reflecting volume reduction. Baseline AVM flow and volume both predicted obliteration. QMRA provides additional non-invasive information to monitor patients after radiosurgical treatment. [ABSTRACT FROM AUTHOR]

This review summarizes the clinical evidence supporting the utilization of stereotactic body radiotherapy (SBRT) for liver tumors, including hepatocellular carcinoma, liver metastases, and cholangiocarcinoma. Emerging prospective evidence has demonstrated the benefit and low rates of toxicity across a broad range of clinical contexts. We provide an introduction for the interventional radiologist, with a discussion of underlying themes such as tumor dose–response, mitigation of liver toxicity, and the technical considerations relevant to performing liver SBRT. Ultimately, we recommend that SBRT should be routinely included in the armamentarium of locoregional therapies for liver malignancies, alongside those liver-directed therapies offered by interventional radiology. [ABSTRACT FROM AUTHOR]