Treatment outcome and radioiodine dose-response in differentiated thyroid carcinoma

Radioiodine (131I) has been used to treat differentiated thyroid carcinoma for the past fifty years. The activity administered remains empirical and most clinicians prescribe a fixed activity for ablation and therapy based upon experience and likely side effects. This lack of tumour dosimetry contrasts sharply with planning for external beam radiotherapy where precise tumour-dose prescription is mandatory. Estimation of absorbed radiation dose delivered to target tissue has been largely ignored in the past partly beacuse of the difficulty in measuring that part of the target volume which is metabolically active. Where absorbed dose has been estimated there is no consensus as to what absorbed dose should be delivered in order to destroy thyroid remnants and metastatic lesions. In order to calculate the absorbed radiation dose to those tissues which concentrate radioiodine, three parameters must be determined: the initial activity in the target tissue; the effective half-life of the radioiodine and the mass of tissue. Tumour and normal thyroid absorbed doses have been determined using a dual-headed whole-body scanner with special high- resolution low-sensitivity collimators. Improved accuracy in the estimation of functioning tumour mass has been achieved using positron emission tomography with a low-cost large area multi-wire proportional chamber camera, developed by the Physics Department of the Royal Marsden Hospital in collaboration with the Rutherford Appleton Laboratories. Dosimetry studies were performed for 54 patients with differentiated thyroid carcinoma (40 papillary, 14 follicular). There were 39 females and 15 males, ages 22 to 79 years. Dose-response graphs have been constructed in order to determine the tumouricidal dose for differentiated thyroid carcinoma metastases and thus enable precise activities of radioiodine to be prescribed in order to maximise tumour kill and minimise morbidity. The clinical data demonstrate that the administration of fixed activities of radioiodine results in a very large range of radiation absorbed dose to residual normal thyroid tissue and metastases of differentiated thyroid carcinoma. Following near-total thyroidectomy and 3.0 GBq 131I, a mean absorbed dose of 349 Gy achieved complete ablation of thyroid remnants in 67[percent] of patients (73[percent] of sites). Patients who had persistent uptake in the thyroid region on subsequent radioiodine scanning had received a mean absorbed dose of only 80 Gy. Failure to ablate may be attributed to two possible factors: large residua following less than radical surgery and the presence of tumour in association with normal tissue. Radioiodine therapy appears to be most effective in destroying small volumes of tissue after optimum surgical cytoreduction. Moreover, when tumour remains in association with normal tissue, the results here indicate that a much lower concentration of radioiodine can be achieved. For these two groups of patients, higher activities of are indicated. Successful destruction of cervical node metastases has been accomplished with absorbed doses of 150 Gy following functional neck dissection. Bone metastases, which are generally associated with a poor prognosis, require doses in excess of 100 Gy for eradication but this can be achieved for solitary deposits following initial surgical debulking. Nevertheless, worthwhile palliation may still be achieved with absorbed doses lower than this. However, the clinical data suggest that absorbed doses less than 20 Gy are sub-therapeutic and that alternative therapy should be considered if less than this can be achieved with radioiodine therapy. The dose-response data explain the spectrum of clinical response to fixed activities of radioiodine. In future they will enable precise prescription of radioiodine to achieve tumouricidal doses whilst avoiding the morbidity, staff hazards and expense of ineffective therapy

First time stroke survivors' perceptions of their health status and their goals for recovery

Stroke is an intensely individual, complex and life changing experience. Stroke recovery has many dimensions, and perceptions of health status are thought to affect recovery. The purpose of this qualitative study was to describe patients' perceptions of their health status and their goals for recovery from early post stroke. Following ethical approval, semi structured interviews were conducted with patients (n=10) diagnosed with a first incident of stroke. Time following stroke onset ranged from 4 to 7 days. Gender difference was equal, and mean age of participants was 77 years. Participants considered themselves to be active and in excellent health prior to the stroke onset. All participants perceived that their health had declined since the stroke onset, but they were hopeful for the future. Two distinct themes emerged; "sudden fear and helplessness" and "regaining control in life". Participants reported wanting to quickly return to doing everyday things and identified individual goals for recovery. The patients' experience should be considered early post stroke to provide a complete picture of their role in recovery. Participants believed that the greatest challenge would be testing themselves at home. This study reinforces the importance of engaging with patients early post stroke so that recovery goals are identified that help restore meaning through the re-establishment of previous activities. Patient goals for recovery need to be discussed and devised in conjunction with health care professionals

TIDE:A novel approach to constructing timed-release encryption

In ESORICS 2021, Chvojka et al. introduced the idea of taking a time-lock puzzle and using its solution to generate the keys of a public key encryption (PKE) scheme [13]. They use this to define a timed- release encryption (TRE) scheme, in which the secret key is encrypted ‘to the future’ using a time-lock puzzle, whilst the public key is published. This allows multiple parties to encrypt a message to the public key of the PKE scheme. Then, once a solver has spent a prescribed length of time evaluating the time-lock puzzle, they obtain the secret key and hence can decrypt all of the messages. In this work we introduce TIDE (TIme Delayed Encryption), a novel approach to constructing timed-release encryption based upon the RSA cryptosystem, where instead of directly encrypting the secret key to the future, we utilise number-theoretic techniques to allow the solver to factor the RSA modulus, and hence derive the decryption key. We implement TIDE on a desktop PC and on Raspberry Pi devices validating that TIDE is both efficient and practically implementable. We provide evidence of practicality with an extensive implementation study detailing the source code and practical performance of TIDE

Derry/Londonderry report on upholding the right to human rights to culture in post-conflict societies

This report was based on research commissioned by the Northern Ireland Human Rights Commission in 2013. It provides an overview of critique of relevant international standards addressing cultural rights; identifies examples of good practice and areas were problems have arisen and uses the City/Londonderry City of Culture 2013 designation as a case-study of the opportunities and challenges in relation to the realisation of the right to culture in post-conflict and divided societies

Regeneration in Vulnerable Communities: Resident and Stakeholder Perspectives

This article assesses the implementation of a regeneration programme in a disadvantaged area in the south of Ireland, with particular focus on how residents in vulnerable circumstances have been supported in the face of multiple crises including economic recession and austerity, service reductions and cutbacks, risk of poverty and social exclusion, and neighbourhood change. The article draws on longitudinal qualitative and quantitative data generated over the time frame of a decade through research with residents, community organisations, and the municipal authority. Drawing on the principles of sustainable regeneration, i.e., physical, social, economic, and environmental dimensions, the article explores the effectiveness and outcomes of regeneration strategies on improving estate liveability and the quality of life of residents across multiple themes and indicators. The key themes explored include supports across the life course, community safety and public realm, education and opportunity, and well‐being and resilience. Through this analysis, the article aims to better understand the experiences of residents in vulnerable circumstances and the impacts, both positive and negative, of a major regeneration programme on their lives

The Derry/Londonderry report on upholding the human right to culture in post-conflict societies

The Northern Ireland Human Rights Commission (the Commission) is mandated as a national human rights institution to uphold all of the human rights in the international human rights treaties. These include the right to culture. However, the Commission has found that little attention has been paid to cultural rights in human rights discourse. In particular, the promotion and protection of cultural rights in societies emerging from conflict is a neglected area. Little guidance exists for States, cultural stakeholders and such human rights actors as national human rights institutions as to how best to uphold cultural rights in such contexts. This gap is of particular concern for the promotion of cultural rights in Northern Ireland, a society that is emerging from decades of conflict. It is in order to redress this gap in literature and policy guidance that the Commission is publishing the present report. The report is set against the backdrop of the designation of Derry/Londonderry as UK City of Culture 2013. The experience of that city as City of Culture is used as a case study in relation to the realisation of cultural rights in a post-conflict society. As part of the UK City of Culture initiative, the Commission organised a conference and consultation on cultural rights in divided and post-conflict societies in association with the University of Ulster and in co-operation with the UN Special Rapporteur in the Field of Cultural Rights, Ms Farida Shaheed. This event took place in Derry/Londonderry from 1 to 3 July 2013 and the discussions that took place informed the finalisation of the current report as well as the attached recommendations

Stop with the FLO: using text messaging to improve retention rates in University Students

Student attrition rates in undergraduate programmes are unacceptably high. The study undertaken evaluated the use of ‘FLO’, a mobile phone automated text messaging service, designed to provide information, support and reassurance in order to help alleviate the stress and anxieties that some new undergraduate students experience during the early phase of their studies. The objectives of the study were to evaluate how use of automated mobile phone texts using a system known as FLO could usefully supplement the pastoral support currently offered to new undergraduate students. A qualitative and quantitative evaluation was conducted using an open-ended questionnaire designed specifically for the study.The sample were 39 first year, undergraduate, Level 4 students from Social Welfare Law (n=16) and Sport and Exercise (n=23) who signed up to receive texts from FLO. The questionnaire was administered in a classroom situation one week after use of FLO had ceased. Data were analysed through use of a descriptive statistics and thematic analysis. Thirty nine students signed up to receive texts from FLO and 25 (64%) completed the Qualtrics questionnaire. Largely positive findings predominated including that text messages increased a sense of belonging to the University and helped students to stay on the course. It is concluded that FLO or use of similar mobile phone protocols may be a useful addition to approaches to improve undergraduate student retention rates

Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC)

BACKGROUND: Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC). METHODS: A cohort of 803 community dwelling older adults were scored for frailty by their public health nurse (PHN) using the Clinical Frailty Scale (CFS) and for risk of three adverse outcomes: i) institutionalisation, ii) hospitalisation and iii) death, within the next year, from one (lowest) to five (highest) using the RISC. Prior to scoring, PHNs stated whether they regarded patients as frail. RESULTS: The median age of patients was 80 years (interquartile range 10), of whom 64% were female and 47.4% were living alone. The median Abbreviated Mental Test Score (AMTS) was 10 (0) and Barthel Index was 18/20 (6). PHNs regarded 42% of patients as frail, while the CFS categorized 54% (scoring ≥5) as frail. Dividing patients into low-risk (score one or two), medium-risk (score three) and high-risk (score four or five) using the RISC showed that 4.3% were considered high risk of institutionalization, 14.5% for hospitalization, and 2.7% for death, within one year of the assessment. There were significant differences in median CFS (4/9 versus 6/9 versus 6/9, p < 0.001), Barthel Index (18/20 versus 11/20 versus 14/20, p < 0.001) and mean AMTS scores (9.51 versus 7.57 versus 7.00, p < 0.001) between those considered low, medium and high risk of institutionalisation respectively. Differences were also statistically significant for hospitalisation and death. Age, gender and living alone were inconsistently associated with perceived risk. Frailty most closely correlated with functional impairment, r = −0.80, p < 0.001. CONCLUSION: The majority of patients in this community sample were perceived to be low risk for adverse outcomes. Frailty, cognitive impairment and functional status were markers of perceived risk. Age, gender and social isolation were not and may not be useful indicators when triaging community dwellers. The RISC now requires validation against adverse outcomes

Primary reading exercises for use with the Durrell Analysis of Reading Difficulty

Thesis (Ed.M.)--Boston Universit