Older adults and the unique role of the radiation therapist: Future directions for improving geriatric oncology training and education.

There is widespread recognition that the provision of high quality, appropriate and equitable care to older adults with cancer is a growing challenge in oncology practice. Radiation therapy (RT) is an effective and localised treatment that represents an attractive curative or palliative option for many older adults, and radiation therapists (RTT) play an important role in the delivery, support and quality of care for people during RT. The need to develop an evidence-based, global approach to improving all radiation oncology (RO) professionals' knowledge and clinical practice in geriatric oncology (GO) has been previously identified. This article specifically focusses on the status quo of GO clinical practice and education for RTT worldwide. We explore the unique clinical role that RTT play in the management of older adults with cancer and define multiple clinical care points in which RTT could potentially participate in geriatric screening, geriatric assessment and intervention to optimise the care of older adults, with a focus on dementia. Directions for future efforts to improve the knowledge and clinical skills of RTT in caring for older adults are discussed

Statistical Agent Based Modelization of the Phenomenon of Drug Abuse

We introduce a statistical agent based model to describe the phenomenon of drug abuse and its dynamical evolution at the individual and global level. The agents are heterogeneous with respect to their intrinsic inclination to drugs, to their budget attitude and social environment. The various levels of drug use were inspired by the professional description of the phenomenon and this permits a direct comparison with all available data. We show that certain elements have a great importance to start the use of drugs, for example the rare events in the personal experiences which permit to overcame the barrier of drug use occasionally. The analysis of how the system reacts to perturbations is very important to understand its key elements and it provides strategies for effective policy making. The present model represents the first step of a realistic description of this phenomenon and can be easily generalized in various directions.Comment: 12 pages, 5 figure

Forecasting Future Procurement Potential of Swedish Forest Biomass Using Forest Inventory Data

In the last 20 years the use of forest biomass for energy production and sawlog and pulpwood production has increased by 68%, 11% and 31% in Sweden. As Sweden is trying to achieve net zero greenhouse gas emissions by 2045, the high demand for biomass can also be expected in future. Therefore, a method to project the amount of spatially available biomass assortments for industries was developed. Available amounts of different forest assortments were estimated and visualised in a web-based tool using forest inventory data and nationwide projection analyses of available biomass for 2035–2039. In this interval, the greatest amount of available biomass and roundwood will be in Northern Sweden. Results also indicate that already existing harvesting intensity is very high compared to the available biomass in the future. The industry can expect noticeably more available biomass in the coming 100 year period. With increased competition between large pulp mills and biorefineries, the supply areas can exceed 200 km to satisfy raw material demand. The long distance and high volume supply chain requirements will demand further improvement in transportation solution nationally and cross-border in the Baltic Sea Region

A systematic review of the overlap of fluid biomarkers in delirium and advanced cancer-related syndromes.

BACKGROUND:Delirium is a serious and distressing neurocognitive disorder of physiological aetiology that is common in advanced cancer. Understanding of delirium pathophysiology is largely hypothetical, with some evidence for involvement of inflammatory systems, neurotransmitter alterations and glucose metabolism. To date, there has been limited empirical consideration of the distinction between delirium pathophysiology and that of the underlying disease, for example, cancer where these mechanisms are also common in advanced cancer syndromes such as pain and fatigue. This systematic review explores biomarker overlap in delirium, specific advanced cancer-related syndromes and prediction of cancer prognosis. METHODS:A systematic review (PROSPERO CRD42017068662) was conducted, using MEDLINE, PubMed, Embase, CINAHL, CENTRAL and Web of Science, to identify body fluid biomarkers in delirium, cancer prognosis and advanced cancer-related syndromes of interest. Studies were excluded if they reported delirium tremens only; did not measure delirium using a validated tool; the sample had less than 75% of participants with advanced cancer; measured tissue, genetic or animal biomarkers, or were conducted post-mortem. Articles were screened for inclusion independently by two authors, and data extraction and an in-depth quality assessment conducted by one author, and checked by two others. RESULTS:The 151 included studies were conducted in diverse settings in 32 countries between 1985 and 2017, involving 28130 participants with a mean age of 69.3 years. Seventy-one studies investigated delirium biomarkers, and 80 studies investigated biomarkers of an advanced cancer-related syndrome or cancer prognosis. Overall, 41 biomarkers were studied in relation to both delirium and either an advanced cancer-related syndrome or prognosis; and of these, 24 biomarkers were positively associated with either delirium or advanced cancer syndromes/prognosis in at least one study. The quality assessment showed large inconsistency in reporting. CONCLUSION:There is considerable overlap in the biomarkers in delirium and advanced cancer-related syndromes. Improving the design of delirium biomarker studies and considering appropriate comparator/controls will help to better understanding the discrete pathophysiology of delirium in the context of co-existing illness

Power law creep and delayed failure of gels and fibrous materials under stress

Motivated by recent experiments studying the creep and breakup of a protein gel under stress, we introduce a simple mesoscopic model for the irreversible failure of gels and fibrous materials, and demonstrate it to capture much of the phenomenology seen experimentally. This includes a primary creep regime in which the shear rate decreases as a power law over several decades of time, a secondary crossover regime in which the shear rate attains a minimum, and a tertiary regime in which the shear rate increases dramatically up to a finite time singularity, signifying irreversible material failure. The model also captures a linear Monkman–Grant scaling of the failure time with the earlier time at which the shear rate attained its minimum, and a Basquin-like power law scaling of the failure time with imposed stress, as seen experimentally. The model furthermore predicts a slow accumulation of low levels of material damage during primary creep, followed by the growth of fractures leading to sudden material failure, as seen experimentally

Energy recovery through co-pyrolysis of wastewater sludge and forest residues – The transition from laboratory to pilot scale

peer-reviewedAnaerobically digested sewage sludge mixed with forest residues was pyrolysed at 800 ◦C, at laboratory and pilot scale. The study quantified differences in char and gas yields for tests carried out in a simple fixed bed laboratory reactor and rotating retort pyrolyser at pilot scale, when the residence time of feedstock was 10 min in both cases. The yield of char from pilot scale was 4 % lower than from laboratory scale while the yield of gas was 15.7 % higher. During the pilot scale pyrolysis of anaerobically digested sewage sludge blended with forest residues the gas quality for energy recovery applications was assessed and the fate of impurities (tar, NH3 and H2S) was investigated. The raw pyrolysis gas contained 14.6 g/Nm3 of tar, 36.9 g/Nm3 of NH3 and 793 ppm of H2S. Sixteen N-containing tar species were identified of which pyridine, propenenitrile, 2 methyl-, benzonitrile, and indole are found to be the most abundant. The yield of N-containing tar compounds accounted for approx. 12 % of total tar content. Conditioned pyrolysis gas contained 7.1 g/Nm3 of tar, 0.036 g/Nm3 of NH3 and 119 ppm of H2S. Benzene was by far the most abundant tar compound followed by toluene and styrene. The specifications of the used internal combustion engine were exceeded due to the sum of tar compounds such as fluorantrene and pyrene with 4+ aromatic rings (at 0.0015 g/Nm3nd NH3 content The effectiveness and sustainability of energy recovery in wastewater treatment can be improved using forest industry by-products

Systems to identify potentially inappropriate prescribing in people with advanced dementia: A systematic review

© 2016 The Author(s). Background: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. Methods: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. Results: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios. Conclusions: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications

Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.

PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing

A collateral benefit of research in palliative care

A collateral benefit of being in a research-active clinical unit is that there is evidence that better care is delivered. The most dramatic data to date demonstrate that in cardiology, research- active cardiology departments in community and university hospitals deliver better survival than those units that do not enroll people in clinical trials

Mutagenic and antimutagenic properties of some lichen species grown in the Eastern Anatolia Region of Turkey

All the methanol extracts did not show mutagenic activity in Ames/Salmonella and Z. mays MI test systems. Furthermore, some extracts showed significant antimutagenic activity against 9-AA in Ames test system. Inhibition rates for 9-AA mutagenicity ranged from 25.51 % (P. furfuracea – 0.05 μg/plate) to 66.14 % (C. islandica – 0.05 μg/plate). In addition, all of the extracts showed significant antimutagenic activity against sodium azide (NaN₃) mutagenicity on MI values of Z. mays.Целью работы было изучить мутагенный и антимутагенный потенциал метанольных экстрактов Cetraria islandica (L.) Ach. (Parmeliaceae), Pseudevernia furfuracea (L.) Zopf (Parmeliaceae) и Xanthoparmelia somloënsis (Gyeln.) Hale (Parmeliaceae) – лишайников из восточной части Турции. Ни один из экстрактов не показал мутагенной активности в тестах Эймса и Z. mays MI. Более того, некоторые экстракты проявляли заметную антимутагенную активность против 9-амино-акридина в тесте Эймса. Уровень ингибирования варьировал от 25,51 % (P. furfuracea) до 66,14 % (C. islandica). Кроме того, все экстракты проявляли значительную антимутагенную активность против азида натрия в Z. mays MI тесте. Все экстракты могут считаться генотоксично безопасными в исследованных концентрациях