117 research outputs found
Outsourcing and insourcing of organizational activities: the role of outsourcing process mechanisms
The decision to outsource organizational activities is studied widely, but research on the insourcing of outsourced activities is scarce. We study the outsourcing decision as a process, and investigate the influences of organizational mechanisms on its sustainability. We argue that organizational learning from the outsourcing decision process could over time result in competencies that enhance the sustainability of outsourcing decisions. We examine outsourcing and insourcing processes longitudinally. The results indicate that the outsourcing process mechanisms, especially the mechanisms associated with implementing the outsourcing decision, predict insourcing. We discuss the implications for future research on outsourcing and insourcing of public services
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Recent Results of Radiation Hydrodynamic and Turbulence Experiments in Cylindrical Geometry
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RAGE simulations of single-mode Richtmyer-Meshkov growth in a convergent geometry
The Richtmyer-Meshkov (RM) instability is initiated by a shock accelerating an interface between two materials. Small perturbations of the interface grow into bubble and spike structures causing mixing of the materials that lie on either side of the interface. Recent Los Alamos National Laboratory experiments have focused on RM initiated mix in a compressible, miscible, convergent geometry. Motivated by the lack of a generally accepted model for this physical regime, cylindrical implosion experiments of single-mode, nonlinear RM growth and saturation are undeway at the OMEGA laser facility. Initial targets consist of an m=28 perturbation with an initial amplitude of 2.5 microns machined onto an aluminum marker layer embedded 55 {micro}m from the target surface. Initial perturbations of varying amplitudes and wavelengths are being studied using the RAGE code
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Calculations of double cylinder implosions at OMEGA
Foam-filled double cylinder targets have been imploded by the OMEGA laser at the University of Rochester. A marker layer of heavier material is placed between the foam and the outside ablator. The marker layer is hydrodynamically unstable when a strong shock passes through both these interfaces and the marker layer material mixes into the foam and the ablator. These experiments thus measure mix in the compressible, convergent, miscible, strong-shock regime. With double cylinder targets, the initial shock converges on the central cylinder and then rebounds and expands. The shock is predicted to create even more mixing of the marker layer as it traverses the previously mixed region. The strength of the reflected shock can be varied by changing the materials in the inner cylinder. Calculations of these implosions using the AMR code, RAGE, are presented for the several target designs. The 2-d calculations give the hydrodynamic evolution of the implosion, shock timings, and the growth of the mix width. The calculations include the effects of surface roughness in the marker layer. Simulated radiographs of the cylindrical implosions are also shown
Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines.
BACKGROUND AND PURPOSE: The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS: An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS: The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS: Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS)
A nationwide study on reproductive function, ovarian reserve, and risk of premature menopause in female survivors of childhood cancer: design and methodological challenges
<p>Abstract</p> <p>Background</p> <p>Advances in childhood cancer treatment over the past decades have significantly improved survival, resulting in a rapidly growing group of survivors. However, both chemo- and radiotherapy may adversely affect reproductive function. This paper describes the design and encountered methodological challenges of a nationwide study in the Netherlands investigating the effects of treatment on reproductive function, ovarian reserve, premature menopause and pregnancy outcomes in female childhood cancer survivors (CCS), the DCOG LATER-VEVO study.</p> <p>Methods</p> <p>The study is a retrospective cohort study consisting of two parts: a questionnaire assessing medical, menstrual, and obstetric history, and a clinical assessment evaluating ovarian and uterine function by hormonal analyses and transvaginal ultrasound measurements. The eligible study population consists of adult female 5-year survivors of childhood cancer treated in the Netherlands, whereas the control group consists of age-matched sisters of the participating CCS. To date, study invitations have been sent to 1611 CCS and 429 sister controls, of which 1215 (75%) and 333 (78%) have responded so far. Of these responders, the majority consented to participate in both parts of the study (53% vs. 65% for CCS and sister controls respectively). Several challenges were encountered involving the study population: dealing with bias due to the differences in characteristics of several types of (non-) participants and finding an adequately sized and well-matched control group. Moreover, the challenges related to the data collection process included: differences in response rates between web-based and paper-based questionnaires, validity of self-reported outcomes, interpretation of clinical measurements of women using hormonal contraceptives, and inter- and intra-observer variation of the ultrasound measurements.</p> <p>Discussion</p> <p>The DCOG LATER-VEVO study will provide valuable information about the reproductive potential of paediatric cancer patients as well as long-term survivors of childhood cancer. Other investigators planning to conduct large cohort studies on late effects may encounter similar challenges as those encountered during this study. The solutions to these challenges described in this paper may be useful to these investigators.</p> <p>Trial registration</p> <p>NTR2922; <url>http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2922</url></p
Management of the vertebrae as an organ at risk in paediatric radiotherapy clinical trials: Initial QUARTET experience
Irradiation of the vertebrae in prepubertal patients, if non-homogenous, can result in future growth deformities including kyphoscoliosis. Vertebral delineation and dosimetry were assessed for 101 paediatric cases reviewed within QUARTET-affiliated trials. Despite the availability of published consensus guidelines, a high variability in vertebral delineation was observed, with impact on dosimetry
Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines
BACKGROUND AND PURPOSE: The purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. MATERIALS AND METHODS: An international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel's clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. RESULTS: The survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. CONCLUSIONS: Consensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS)
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