Recognition of differences in the capacity to deal with floods—A cross-country comparison of flood risk management

Flood risks worldwide are increasing due to climate change. Managing these risks is ever more necessary. Although flood risk management (FRM) is often understood as a technical challenge, it also involves decisions about the distribution of resources and risks in floods, which can be inherently unfair. People are disparately affected by floods due to their location. Because of their various socioeconomic and demographic characteristics, they also differ in their capacity to deal with floods. These differences need to be recognised in FRM to prevent disproportionate impacts on vulnerable communities. However, at present, a knowledge gap exists on how to make FRM more inclusive and just, and discussions on recognition justice in the context of FRM are scarce. This article therefore examines recognition of differences in the capacity of people to deal with floods in FRM in England (United Kingdom), Finland, Flanders (Belgium) and France. We analyse if, and how, these differences are recognised in FRM policy and practice and through decision-making procedures, drawing on examples from the implementation of five FRM strategies in each country (flood risk prevention, flood defence, flood risk mitigation, flood preparation and flood recovery). Furthermore, we aim to highlight opportunity spaces to strengthen recognition justice in future FRM

A Modality-Adaptive Method for Segmenting Brain Tumors and Organs-at-Risk in Radiation Therapy Planning

In this paper we present a method for simultaneously segmenting brain tumors and an extensive set of organs-at-risk for radiation therapy planning of glioblastomas. The method combines a contrast-adaptive generative model for whole-brain segmentation with a new spatial regularization model of tumor shape using convolutional restricted Boltzmann machines. We demonstrate experimentally that the method is able to adapt to image acquisitions that differ substantially from any available training data, ensuring its applicability across treatment sites; that its tumor segmentation accuracy is comparable to that of the current state of the art; and that it captures most organs-at-risk sufficiently well for radiation therapy planning purposes. The proposed method may be a valuable step towards automating the delineation of brain tumors and organs-at-risk in glioblastoma patients undergoing radiation therapy.Comment: corrected one referenc

Long-term toxicity and efficacy of FLASH radiotherapy in dogs with superficial malignant tumors

Introduction: FLASH radiotherapy (RT) has emerged as a promising modality, demonstrating both a normal tissue sparing effect and anticancer efficacy. We have previously reported on the safety and efficacy of single fraction FLASH RT in the treatment of oral tumors in canine cancer patients, showing tumor response but also a risk of radiation-induced severe late adverse effects (osteoradionecrosis) for doses ≥35 Gy. Accordingly, the objective in this study was to investigate if single fraction high dose FLASH RT is safe for treating non-oral tumors. Methods: Privately-owned dogs with superficial tumors or microscopic residual disease were included. Treatment was generally delivered as a single fraction of 15-35 Gy 10 MeV electron FLASH RT, although two dogs were re-irradiated at a later timepoint. Follow-up visits were conducted up to 12 months post-treatment to evaluate treatment efficiency and adverse effects. Results: Fourteen dogs with 16 tumors were included, of which nine tumors were treated for gross disease whilst seven tumors were treated post-surgery for microscopic residual disease. Four treatment sites treated with 35 Gy had ulceration post irradiation, which was graded as severe adverse effect. Only mild adverse effects were observed for the remaining treatment sites. None of the patients with microscopic disease experienced recurrence (0/7), and all patients with macroscopic disease showed either a complete (5/9) or a partial response (4/9). Five dogs were euthanized due to clinical disease progression. Discussion: Our study demonstrates that single fraction high dose FLASH RT is generally safe, with few severe adverse effects, particularly in areas less susceptible to radiation-induced damage. In addition, our study indicates that FLASH has anti-tumor efficacy in a clinical setting. No osteoradionecrosis was observed in this study, although other types of high-grade adverse effects including ulcer-formations were observed for the highest delivered dose (35 Gy). Overall, we conclude that osteoradionecrosis following single fraction, high dose FLASH does not appear to be a general problem for non-oral tumor locations. Also, as has been shown previously for oral tumors, 30 Gy appeared to be the maximum safe dose to deliver with single fraction FLASH RT

Inducing institutional change through projects? : Three models of projectified governance

The study of short-term projects to implement policy has lately gained ground among scholars of environmental governance and public administration. The increasing reliance on and prevalence of projects, or ‘projectification’, has spurred critical debates on the ability of projects to contribute to long-term goals, including sustainability, as well as institutional change. Yet, the literature on projectification lacks specificity in terms of how projects are understood, how the relationship between projects and permanent organizations looks like, and how projects can influence institutional orders. The aim of this paper is to systematize the literature in order to uncover the process of transforming project outputs into institutional change. Three models of projectified governance – mechanistic, organic, and adaptive – is presented, providing a conceptual apparatus that advances the study of projects in environmental policy and governance. The paper argues that the adaptive model, with its reliance on multi-scalar networks for the coordination of project activities and knowledge, shows most promise in achieving institutional change to address complex environmental problems.Peer reviewe

A modality-adaptive method for segmenting brain tumors and organs-at-risk in radiation therapy planning

In this paper we present a method for simultaneously segmenting brain tumors and an extensive set of organs-at-risk for radiation therapy planning of glioblastomas. The method combines a contrast-adaptive generative model for whole-brain segmentation with a new spatial regularization model of tumor shape using convolutional restricted Boltzmann machines. We demonstrate experimentally that the method is able to adapt to image acquisitions that differ substantially from any available training data, ensuring its applicability across treatment sites; that its tumor segmentation accuracy is comparable to that of the current state of the art; and that it captures most organs-at-risk sufficiently well for radiation therapy planning purposes. The proposed method may be a valuable step towards automating the delineation of brain tumors and organs-at-risk in glioblastoma patients undergoing radiation therapy

A modality-adaptive method for segmenting brain tumors and organs-at-risk in radiation therapy planning

In this paper we present a method for simultaneously segmenting brain tumors and an extensive set of organs-at-risk for radiation therapy planning of glioblastomas. The method combines a contrast-adaptive generative model for whole-brain segmentation with a new spatial regularization model of tumor shape using convolutional restricted Boltzmann machines. We demonstrate experimentally that the method is able to adapt to image acquisitions that differ substantially from any available training data, ensuring its applicability across treatment sites; that its tumor segmentation accuracy is comparable to that of the current state of the art; and that it captures most organs-at-risk sufficiently well for radiation therapy planning purposes. The proposed method may be a valuable step towards automating the delineation of brain tumors and organs-at-risk in glioblastoma patients undergoing radiation therapy

ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma

BACKGROUND AND PURPOSE Target delineation in glioblastoma is still a matter of extensive research and debate. This guideline aims to update the existing joint European consensus on delineation of the clinical target volume (CTV) in adult glioblastoma patients. MATERIAL AND METHODS The ESTRO Guidelines Committee identified 14 European experts in close interaction with the ESTRO clinical committee and EANO who discussed and analysed the body of evidence concerning contemporary glioblastoma target delineation, then took part in a two-step modified Delphi process to address open questions. RESULTS Several key issues were identified and are discussed including i) pre-treatment steps and immobilisation, ii) target delineation and the use of standard and novel imaging techniques, and iii) technical aspects of treatment including planning techniques and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a reduced 15 mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS The EORTC consensus recommends a single clinical target volume definition based on postoperative contrast-enhanced T1 abnormalities, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised; this should usually be no greater than 3 mm when using IGRT

Transformational responses to climate change: beyond a systems perspective of social change in mitigation and adaptation

There is a growing imperative for responses to climate change to go beyond incremental adjustments, aiming instead for society-wide transformation. In this context, sociotechnical (ST) transitions and social–ecological (SE) resilience are two prominent normative agendas. Reviewing these literatures reveals how both share a complex-systems epistemology with inherent limitations, often producing managerial governance recommendations and foregrounding material over social drivers of change. Further interdisciplinary dialogue with social theory is essential if these frameworks are to become more theoretically robust and capable of informing effective, let alone transformational, climate change governance. To illustrate this potential, ideas from Deleuze and Guattari's political writing as well as other approaches that utilize the notion social fields (as opposed to sociosystems) are combined to more fully theorize the origins and enactment of social change. First, the logic of systems is replaced with the contingency of assemblages to reveal how pluralism, not elitism, can produce more ambitious and politicized visions of the future. In particular, this view encourages us to see social and ecological tensions as opportunities for thinking and acting differently rather than as mere technical problems to be solved. Secondly, the setting of social fields is introduced to situate and explain the power of ideas and the role of agency in times of uncertainty. The potential of such insights is already visible in some strands of climate change mitigation and adaptation research, but more needs to be done to advance this field and to bring it into dialogue with the mainstream systems based literature