Rapport au Roi Souverain : rapport de la Commission d'Enquête ; A. M. le Secrétaire d'État de l'État Indépendant du Congo [31 octobre 1905]

Bakgrund: Den palliativa vården för hälso- och sjukvårdspersonal innebär att försöka uppnå den döende personens maximala livskvalitet och att lindra lidandet. Vården lutar sig mot det nationella vårdprogrammet för palliativ vård samt International Council of Nurses, ICN. Sjuksköterskans roll och uppgifter inom vården beskrivs där även de fyra hörnstenarna belyses. Syfte: Att belysa sjuksköterskornas upplevda svårigheter vid vård av patienter med palliativ diagnos. Metod: Examensarbetet är en litteraturöversikt baserad på Fribergs analysmetod. Denna litteraturöversikt inkluderar tio vetenskapliga artiklar som har sökts i databaserna CINAHL Complete och PubMed. Som en teoretisk utgångspunkt har Patricia Benners teori från novis till expert valts som en diskussion i resultatdiskussionen. Resultat: Sjuksköterskornas upplevda svårigheter av att vårda patienter med en palliativ diagnos resulterade i fyra huvudteman i litteraturöversikten; kommunikation, närstående och relation, vårdteamet samt kunskap och erfarenheter. Diskussion: Resultatet i litteraturöversikten har diskuterats utifrån Benners teori. Sjuksköterskornas upplevda svårigheter belystes genom fyra teman – kunskap och erfarenhet, närståendestöd, kommunikation mellan kollegor och gentemot patienten samt kultur som upplevd svårighet.Background: Palliative care for health professional means trying to achieve the maximum dying person's quality of life and ease suffering. The palliative care for health professionals means to try to achieve the dying person's maximum quality of life and alleviate suffering. The care inclined towards the Swedish national health care program for palliative care and the International Council of Nurses, ICN. The nurse's role and tasks in health care are described where even the four cornerstones elucidated. Aim: To elucidate the nurses perceived difficulties in nursing patients with palliative diagnosis. Method: The thesis is a literature review based on Friberg's analysis. This literature review includes ten scientific articles that have been searched in the databases CINAHL Complete and PubMed. As a theoretical base, Patricia Benner's theory from novice to expert was selected as a discussion of the results discussion. Results: The nurses perceived difficulties of caring for patients with a palliative diagnosis resulted in four main themes in the literature; communication, family and relationship, the health care team as well as knowledge and experience. Discussion: The results of the literature review are discussed based on Benner's theory. The nurses' perceived difficulties irradiated by four themes – knowledge and experience, family support, communication between colleagues and towards the patient as well the culture as perceived difficulties

Evolutionary dynamics and biogeography of Musaceae reveal a correlation between the diversification of the banana family and the geological and climatic history of Southeast Asia

Article PurchasedTropical Southeast Asia, which harbors most of the Musaceae biodiversity, is one of the most species-rich regions in the world. Its high degree of endemism is shaped by the region's tectonic and climatic history, with large differences between northern Indo-Burma and the Malayan Archipelago. Here, we aim to find a link between the diversification and biogeography of Musaceae and geological history of the Southeast Asian subcontinent. The Musaceae family (including five Ensete, 45 Musa and one Musella species) was dated using a large phylogenetic framework encompassing 163 species from all Zingiberales families. Evolutionary patterns within Musaceae were inferred using ancestral area reconstruction and diversification rate analyses. All three Musaceae genera - Ensete, Musa and Musella - originated in northern Indo-Burma during the early Eocene. Musa species dispersed from 'northwest to southeast' into Southeast Asia with only few back-dispersals towards northern Indo-Burma. Musaceae colonization events of the Malayan Archipelago subcontinent are clearly linked to the geological and climatic history of the region. Musa species were only able to colonize the region east of Wallace's line after the availability of emergent land from the late Miocene onwards

Molecular and cytological characterization of the global Musa germplasm collection provides insights into the treasure of banana diversity

© 2016, The Author(s). Bananas (Musa spp.) are one of the main fruit crops grown worldwide. With the annual production reaching 144 million tons, their production represents an important contribution to the economies of many countries in Asia, Africa, Latin-America and Pacific Islands. Most importantly, bananas are a staple food for millions of people living in the tropics. Unfortunately, sustainable banana production is endangered by various diseases and pests, and the breeding for resistant cultivars relies on a far too small base of genetic variation. Greater diversity needs to be incorporated in breeding, especially of wild species. Such work requires a large and thoroughly characterized germplasm collection, which also is a safe depository of genetic diversity. The largest ex situ Musa germplasm collection is kept at the International Transit Centre (ITC) in Leuven (Belgium) and currently comprises over 1500 accessions. This report summarizes the results of systematic cytological and molecular characterization of the Musa ITC collection. By December 2015, 630 accessions have been genotyped. The SSR markers confirmed the previous morphological based classification for 84% of ITC accessions analyzed. The remaining 16% of the genotyped entries may need field verification by taxonomist to decide if the unexpected classification by SSR genotyping was correct. The ploidy level estimation complements the molecular data. The genotyping continues for the entire ITC collection, including newly introduced accessions, to assure that the genotype of each accession is known in the largest global Musa gene bank. Open Access ispartof: Biodiversity and Conservation vol:26 issue:4 pages:801-824 status: publishe

Estimating patient specific uncertainty parameters for adaptive treatment re-planning in proton therapy using in vivo range measurements and Bayesian inference: Application to setup and stopping power errors

In proton therapy, quanti cation of the proton range uncertainty is important to achieve dose distribution compliance. The promising accuracy of prompt gamma imaging (PGI) suggests the development of a mathematical framework using the range measurements to convert population based estimates of uncertainties into patient speci c estimates with the purpose of plan adaptation. We present here such framework using Bayesian inference. The sources of uncertainty were modeled by three parameters: setup bias m, random setup precision r and water equivalent path length bias u. The evolution of the expectation values E(m), E(r) and E(u) during the treatment was simulated. The expectation values converged towards the true simulation parameters after 5 and 10 fractions, for E(m) and E(u), respectively. E(r) settle on a constant value slightly lower than the true value after 10 fractions. In conclusion, the simulation showed that there is enough information in the frequency distribution of the range errors measured by PGI to estimate the expectation values and the con dence interval of the model parameters by Bayesian inference. The updated model parameters were used to compute patient speci c lateral and local distal margins for adaptive re-planning

Estimation of respiratory phases during proton radiotherapy from a 4D-CT and Prompt gamma detection profiles

Proton radiotherapy has a potential to provide an effective cancer treatment while sparing greater volume of healthy tissue than the conventional X-ray based radiotherapy. However, in lungs this potential is hindered by motion due to breathing. An important quantity in treatment verification is the correlation between the respiratory phases (RP) and the timing of pencil beam scanning (PBS). In this note, we demonstrate how the RP can be estimated using Prompt gamma (PG) detection profiles collected during a treatment. We utilized a 4D-CT of a patient with lung cancer, a treatment plan and a PG simulator. The treatment plan consisted of ten layers corresponding to ten proton energies. The RPs of the 4D-CT were interpolated using a deformable registration algorithm, so as to have fifty RPs in total. Deviations from regular breathing were introduced via time dependent frequency modulation. Fifty unique breathing patterns were generated, for which PG profiles were simulated for each pencil beam. Poisson noise was added to each PG profile to account for photon statistics. The RPs were estimated by comparing the PG profiles with and without Poisson noise via three different methods: the RP associated with each layer was estimated 1) independently of the other layers, 2) using a linear correlation between the layers, and 3) using a quadratic correlation between the layers. The best model, the quadratic model, yielded an average error in RP estimation relative to the breathing period of 5% of the breathing period or less with a 90% confidence interval

Generation of prescriptions robust against geometric uncertainties in dose painting by numbers

background. In the context of dose painting by numbers delivered with intensity-modulated radiotherapy, the robust- ness of dose distributions against geometric uncertainties can be ensured by robust optimization. As robust optimization is seldom available in treatment planning systems (TPS), we propose an alternative method that reaches the same goal by modifying the heterogeneous dose prescription (based on 18FDG-PET) and guarantees coverage in spite of systematic and random errors with known standard deviations Σ and s, respectively. Material and methods. The objective was that 95% of all voxels in the GTVPET received at least 95% of the pre- scribed dose despite geometric errors. The prescription was modified by a geometric dilation of aΣ for systematic errors and a deconvolution by a Gaussian function of width s for random errors. For a 90% confidence interval, a = 2.5. Plan- ning was performed on a TomoTherapy system, such that 95% of the voxels received at least 95% of the modified prescription and less than 5% of the voxels received more than 105% of the modified prescription. The applicability of the method was illustrated for two head-and-neck tumors. results. Systematic and random displacements larger than aΣ and s degraded coverage. Down to 62.8% of the points received at least 95% of prescribed dose for the largest considered displacements (5 mm systematic translation and 3 mm standard deviation for random errors). When systematic and random displacements were smaller than aΣ and s, no degradation of target coverage was observed. conclusions. The method led to treatment plans with target coverage robust against geometric uncertainties without the need to incorporate these in the optimizer of the TPS. The methodology was illustrated for head-and-neck cancer but can be potentially extended to all treatment sites

Feasibility of online IMPT adaptation using fast, automatic and robust dose restoration

Intensity-modulated proton therapy (IMPT) offers excellent dose conformity and healthy tissue sparing, but it can be substantially compromised in the presence of anatomical changes. A major dosimetric effect is caused by density changes, which alter the planned proton range in the patient. Three different methods, which automatically restore an IMPT plan dose on a daily CT image were implemented and compared: (1) simple dose restoration (DR) using optimization objectives of the initial plan, (2) voxel-wise dose restoration (vDR), and (3) isodose volume dose restoration (iDR). Dose restorations were calculated for three different clinical cases, selected to test different capabilities of the restoration methods: large range adaptation, complex dose distributions and robust re-optimization. All dose restorations were obtained in less than 5 min, without manual adjustments of the optimization settings. The evaluation of initial plans on repeated CTs showed large dose distortions, which were substantially reduced after restoration. In general, all dose restoration methods improved DVH-based scores in propagated target volumes and OARs. Analysis of local dose differences showed that, although all dose restorations performed similarly in high dose regions, iDR restored the initial dose with higher precision and accuracy in the whole patient anatomy. Median dose errors decreased from 13.55 Gy in distorted plan to 9.75 Gy (vDR), 6.2 Gy (DR) and 4.3 Gy (iDR). High quality dose restoration is essential to minimize or eventually by-pass the physician approval of the restored plan, as long as dose stability can be assumed. Motion (as well as setup and range uncertainties) can be taken into account by including robust optimization in the dose restoration. Restoring clinically-approved dose distribution on repeated CTs does not require new ROI segmentation and is compatible with an online adaptive workflow. © 2018 Institute of Physics and Engineering in Medicine