Small bowel and rectal toxicity after pelvic radiotherapy : histopathological development, the influence of ageing and modulation by conformal treatment

Throughout history, cancer has been one of the major causes of death. It has been estimated that in the western world approximately one in three people will develop some kind of cancer during their lifetime, and one in five will die of it. Longevity is associated with prolonged exposure of somatic cells to environmental carcinogens leading to carcinogenesis in these ageing cells. Therefore, cancer is predominantly a disease related to old age. In The Netherlands, the number of persons over 85 years of age increased from 99.000 in 1976 to 203.000 in 1995 (an increase of 1O5 %). It is predicted that by the year 2015 the total population living in The Netherlands will have increased by 8.4%, from 15.4 million in 1994 to 16.7 million. However the proportion of the population more than 65 years of age is expected to grow much faster (45%), although the proportion of persons of 85 years and older will remain the same. In view of the demographic developments, the number of cancer cases can be expected to increase dramatically in the near future. Compared to 1994, for 2015 an increase varying from 30-60 % for cancer of the colon, prostate and breast has been predicted

Topology of six degrees of freedom magnetic bearing

A novel magnetic topology has been designed for a six degrees of freedom, magnetically levitated and driven mirror, to be used in a three dimensional (3D) measurement system based on laser interferometry. The translations of the mirror are to be kept small, whereas the rotations are to be controlled over a large range with a high bandwidth and high accuracy. Finite element modelling (FEM) is used to analyze the proposed topology. For computational load reduction, a 2D FEM model has been derived from the actual 3D topology, which incorporates most of the magnetic subsystems. Simulations show that cross-influence between the actuators is small, that the forces and torques are proportional to the applied currents and that the angle of the rotor is of little influence. This allows the multiple in multiple out system to be regarded as multiple linear single in single out systems. ©2000 American Institute of Physics

The Japanese model in retrospective : industrial strategies, corporate Japan and the 'hollowing out' of Japanese industry

This article provides a retrospective look at the Japanese model of industrial development. This model combined an institutional approach to production based around the Japanese Firm (Aoki's, J-mode) and strategic state intervention in industry by the Japanese Ministry of International Trade and Industry (MITI). For a long period, the alignment of state and corporate interests appeared to match the wider public interest as the Japanese economy prospered. However, since the early 1990s, the global ambitions of the corporate sector have contributed to a significant 'hollowing out' of Japan's industrial base. As the world today looks for a new direction in economic management, we suggest the Japanese model provides policy-makers with a salutary lesson in tying the wider public interest with those of the corporate sector

"I lost my happiness, I felt half dead and half alive" - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania

Background: This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with

Human Rights Shaming Through INGOs and Foreign Aid Delivery

Does the ``shaming" of human rights violations influence foreign aid delivery decisions across OECD donor countries? We examine the effect of shaming, defined as targeted negative attention by human rights international nongovernmental organizations (INGOs), on donor decisions about how to deliver bilateral aid. We argue that INGO shaming of recipient countries leads donor governments, on average, to ``bypass" the recipient government in favor of non-state aid delivery channels, including international and local NGOs and international organizations (IOs). However, we expect this relationship to be conditional on a donor country's position in the international system. Minor power countries have limited influence in global affairs and are therefore more able to centrally promote human rights in their foreign policy. Major power countries, on the other hand, shape world politics and often confront ``realpolitik" concerns that may require government-to-government aid relations in the presence of INGO shaming. We expect aid officials of minor donor countries to be more likely to condition aid delivery decisions on human rights shaming than their counterparts of major donor countries. Using compositional data analysis, we test our argument using originally collected data on human rights shaming events in a time-series cross-sectional framework from 2004 to 2010. We find support for our hypotheses: On average, OECD donor governments increase the proportion of bypass when INGOs shame the recipient government. When differentiating between donor types we find that this finding holds for minor but not for major powers. These results add to both our understanding of the influences of aid allocation decision-making and our understanding of the role of INGOs on foreign-policy

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