Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning

<p>Abstract</p> <p>Background</p> <p>Chemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological malignancies. Whether IMRT in prone (PP) or supine position (SP) might be beneficial for cervical cancer patients remains partially unanswered.</p> <p>Methods</p> <p>10 patients on FIGO stage IB-III cervical cancer, 6 patients for definitive and 4 patients for adjuvant external beam pelvic RT, were planned in PP and SP using a 7-field IMRT technique. IMRT plans for PP and SP (mean dose, D_mean50.4 Gy) were optimized in terms of PTV coverage (1^stpriority) and small bowel sparing (2^ndpriority). A comparison of DVH parameters for PTV, small bowel, bladder, and rectum was performed.</p> <p>Results</p> <p>The comparison showed a similar PTV coverage of 95% of the prescribed dose and for target conformity in IMRT plans (PP, SP). PTV, rectum and bladder volumes were comparable for PP and SP. Significantly larger volumes of small bowel were found in PP (436 cc, + 35%, p = 0.01). PP decreased the volume of small bowel at 20-50.4 Gy (p < 0.05) and increased the rectum volumes covered by doses from 10-40 Gy (p < 0.01), the V50.4 was < 5% in both treatment positions. Bladder sparing was significant better at 50.4 Gy (p = 0.03) for PP.</p> <p>Conclusion</p> <p>In this dosimetric study, we demonstrated that pelvic IMRT in prone position for patients with cervical cancer seems to be beneficial in reducing small bowel volume at doses ≥20 Gy while providing similar target coverage and target conformity. The use of frequent image guidance with KV (kilovolt) or MV (megavolt) computertomography can reduce set-up deviations, and treatment in prone position can be done with a higher set-up accuracy. Clinical outcome studies are needed to affirm lower toxicity.</p

Recognising Victimhood: Lessons from the International Criminal Court and Mass Claim Programmes for the Compensation Procedure Parallel to the Trial of International Crimes in the Netherlands

In the Netherlands, the Dutch criminal court in The Hague (hereinafter: ‘Netherlands International Crimes Court’ or ‘NIC court’) is assigned to try international crimes, and to provide compensation to victims of such crimes. Whereas it has specific criminal laws at its disposal to try international crimes, it applies ‘regular’ Dutch civil law to assess claims for compensation. Yet compensation for international crimes entails challenges that are quite different from domestic crimes: international crimes are normally committed against a large number of victims, and frequently result in bodily harm. This article argues that the NIC court will most likely rule a large number of claims for compensation inadmissible, as a consequence of which victims cannot benefit from the advantages inherent in the award of compensation within the criminal process. It then explores the adjudicative and reparatory standards that the International Criminal Court and mass claim programmes have applied to simplify both the adjudication of a large number of claims, and the calculation of a large number of instances of bodily damage. It is submitted that adoption by the NIC court of international reparatory standards could facilitate the assessment of a large number of civil claims within the criminal process, without prejudice to the legitimate interests of the defendant for an adequate procedure. However, these standards require the NIC court to strike a new balance between tailor-made compensation and symbolic compensation, and thereby between corrective justice and restorative justice

Benefits of Leapfrogging to Superefficiency and Low Global Warming Potential Refrigerants in Room Air Conditioning

Hydrofluorocarbons (HFCs) emitted from uses such as refrigerants and thermal insulating foam, are now the fastest growing greenhouse gases (GHGs), with global warming potentials (GWP) thousands of times higher than carbon dioxide (CO2). Because of the short lifetime of these molecules in the atmosphere, mitigating the amount of these short-lived climate pollutants (SLCPs) provides a faster path to climate change mitigation than control of CO2 alone. This has led to proposals from Africa, Europe, India, Island States, and North America to amend the Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) to phase-down high-GWP HFCs. Simultaneously, energy efficiency market transformation programs such as standards, labeling and incentive programs are endeavoring to improve the energy efficiency for refrigeration and air conditioning equipment to provide life cycle cost, energy, GHG, and peak load savings. In this paper we provide an estimate of the magnitude of such GHG and peak electric load savings potential, for room air conditioning, if the refrigerant transition and energy efficiency improvement policies are implemented either separately or in parallel. We find that implementing HFC refrigerant transition and energy efficiency improvement policies in parallel for room air conditioning, roughly doubles the benefit of either policy implemented separately. We estimate that shifting the 2030 world stock of room air conditioners from the low efficiency technology using high-GWP refrigerants to higher efficiency technology and low-GWP refrigerants in parallel would save between 340-790 gigawatts (GW) of peak load globally, which is roughly equivalent to avoiding 680-1550 peak power plants of 500MW each. This would save 0.85 GT/year annually in China equivalent to over 8 Three Gorges dams and over 0.32 GT/year annually in India equivalent to roughly twice India’s 100GW solar mission target. While there is some uncertainty associated with emissions and growth projections, moving to efficient room air conditioning (~30% more efficient than current technology) in parallel with low-GWP refrigerants in room air conditioning could avoid up to ~25 billion tonnes of CO2 in 2030, ~33 billion in 2040, and ~40 billion in 2050, i.e. cumulative savings up to 98 billion tonnes of CO2 by 2050. Therefore, superefficient room ACs using low-GWP refrigerants merit serious consideration to maximize peak load reduction and GHG savings

Spatial genetic structure in Beta vulgaris subsp. maritima and Beta macrocarpa reveals the effect of contrasting mating system, influence of marine currents, and footprints of postglacial recolonization routes

Understanding the factors that contribute to population genetic divergence across a species' range is a long‐standing goal in evolutionary biology and ecological genetics. We examined the relative importance of historical and ecological features in shaping the present‐day spatial patterns of genetic structure in two related plant species, Beta vulgaris subsp. maritima and Beta macrocarpa. Using nuclear and mitochondrial markers, we surveyed 93 populations from Brittany (France) to Morocco – the southern limit of their species' range distribution. Whereas B. macrocarpa showed a genotypic structure and a high level of genetic differentiation indicative of selfing, the population genetic structure of B. vulgaris subsp. maritima was consistent with an outcrossing mating system. We further showed (1) a strong geographic clustering in coastal B. vulgaris subsp. maritima populations that highlighted the influence of marine currents in shaping different lineages and (2) a peculiar genetic structure of inland B. vulgaris subsp. maritima populations that could indicate the admixture of distinct evolutionary lineages and recent expansions associated with anthropogenic disturbances. Spatial patterns of nuclear diversity and differentiation also supported a stepwise recolonization of Europe from Atlantic‐Mediterranean refugia after the last glacial period, with leading‐edge expansions. However, cytoplasmic diversity was not impacted by postglacial recolonization: stochastic long‐distance seed dispersal mediated by major oceanic currents may mitigate the common patterns of reduced cytoplasmic diversity observed for edge populations. Overall, the patterns we documented here challenge the general view of reduced genetic diversity at the edge of a species' range distribution and provide clues for understanding how life‐history and major geographic features interact to shape the distribution of genetic diversity.ISSN:2045-775

Who is the Little Old Lady of International Crimes? Nils Christie’s concept of the Ideal Victim Reinterpreted

This article discusses to what extent Nils Christie's famous stereotype of the 'ideal victim' is applicable in a context of international crimes. It argues that the characteristics of the ideal victim of genocide, crimes against humanity and war crimes largely overlap with the ideal victim of conventional crimes. Nevertheless, victims of international crimes face much more difficulty in publicizing their fate and consequently 'benefiting' from their status as victim. It is only when potential status givers are aware of the victims' existence that the victim status can be granted. It is argued that, to grasp international media attention, particular attributes of a conflict should also be present: the conflict should be comprehensible, have a unique selling point, have a limited time span and be well-'timed'. Whether such media attention materializes in actions by international politicians or private humanitarian organizations depends on domestic policies, geopolitical interests, accessibility to the region and the possibility of donors identifying with the victims. © The Author(s) 2013