Low-dose radiotherapy for greater trochanteric pain syndrome-a single-centre analysis.

PURPOSE To determine predictive factors associated with a good response (GR) to and efficacy of low-dose radiotherapy (LDRT) in patients with greater trochanteric pain syndrome (GTPS). METHODS Patients with GTPS were irradiated on a linear accelerator with 0.5-1.0 Gy per fraction to a total dose of 3.0-4.0 Gy per series. The endpoint was subjective good response (GR) to treatment 2 months after completion of the last LDRT series, defined as complete pain relief or marked improvement assessed using the von Pannewitz score. A positive response to steroid injection (SI) was defined as pain relief of at least 7 days. Patient and treatment-related characteristics were evaluated with respect to LDRT outcomes. RESULTS Outcomes were assessed for 71 peritrochanteric spaces (PTSs; 65 patients, 48 females, with mean age of 63 [44-91] years). Prior SI had been given to 55 (77%) PTSs and 40 PTSs received two series of LDRT. Two months after completion of LDRT, GR was reported in 42 PTSs (59%). Two series of LDRT provided a significantly higher rate of GR than one series (72.5 vs. 42% PTSs, p = 0.015). Temporary pain relief after prior SI predicted GR to LDRT compared with PTSs which had not responded to SI (73 vs. 28% PTSs, p = 0.001). A regional structural abnormality, present in 34 PTSs (48%), was associated with a reduction of GR to LDRT (44 vs. 73% PTSs, p = 0.017). CONCLUSION LDRT is an effective treatment for GTPS. Administration of two LDRT series, prior response to SI, and absence of structural abnormalities may predict significantly better treatment outcomes

Cold Spray metal powder deposition with 9 %Cr-steel applied for the HCPB First Wall fabrication: Proof of concept and options for ODS steel processing

At the KIT a hybrid manufacturing concept for nuclear fusion First Walls is developed combining aspects of conventional and Additive Manufacturing (AM) technologies. The state of the art for ITER does not cover all specifications of a DEMO relevant First Wall. Thus, additional R&D-work has been initiated in terms of manufacturing. The AM technology basis used in the presented process combination is Cold Spray metal powder deposition applied in alternation with machining including the feature of filling grooves temporarily with a water-soluble granulate for creation of closed channels and cavities. Thus, the technology provides the option to manufacture shells with a thin gas tight membrane on top of previously machined structures. This membrane is used as pressure seal and makes the joining of shells by Hot Isostatic Pressing (HIP) into one monolithic body possible. This paper describes the manufacturing process and recalls differences and common aspects with regard to conventional concepts of First Wall manufacturing. The achievement of Technology Readiness Level TRL 3 by mechanical qualification and comparison of the results to other HIP joint experiments is also demonstrated. Finally, an outlook is given concerning integration options of the technology into manufacturing of shells with cooling channel structures using Oxide Dispersion Strengthened (ODS) materials

Developing research priorities for palliative care of people with intellectual disabilities in Europe: a consultation process using nominal group technique

BACKGROUND: Empirical knowledge around palliative care provision and needs of people with intellectual disabilities is extremely limited, as is the availability of research resources, including expertise and funding. This paper describes a consultation process that sought to develop an agenda for research priorities for palliative care of people with intellectual disabilities in Europe. METHODS: A two-day workshop was convened, attended by 16 academics and clinicians in the field of palliative care and intellectual disability from six European countries. The first day consisted of round-table presentations and discussions about the current state of the art, research challenges and knowledge gaps. The second day was focused on developing consensus research priorities with 12 of the workshop participants using nominal group technique, a structured method which involved generating a list of research priorities and ranking them in order of importance. RESULTS: A total of 40 research priorities were proposed and collapsed into eleven research themes. The four most important research themes were: investigating issues around end of life decision making; mapping the scale and scope of the issue; investigating the quality of palliative care for people with intellectual disabilities, including the challenges in achieving best practice; and developing outcome measures and instruments for palliative care of people with intellectual disabilities. CONCLUSIONS: The proposal of four major priority areas and a range of minor themes for future research in intellectual disability, death, dying and palliative care will help researchers to focus limited resources and research expertise on areas where it is most needed and support the building of collaborations. The next steps are to cross-validate these research priorities with people with intellectual disabilities, carers, clinicians, researchers and other stakeholders across Europe; to validate them with local and national policy makers to determine how they could best be incorporated in policy and programmes; and to translate them into actual research studies by setting up European collaborations for specific studies that require such collaboration, develop research proposals and attract research funding

Constructive approach to limiting periodic orbits with exponential and power law dynamics

In dynamical systems limit cycles arise as a result of a Hopf bifurcation, after a control parameter has crossed its critical value. In this study we present a constructive method to produce dissipative dynamics which lead to stable periodic orbits as time grows, with predesigned transient dynamics. Depending on the construction method a) the limiting orbit can be a regular circle, an ellipse or a more complex closed orbit and b) the approach to the limiting orbit can follow an exponential law or a power law. This technique allows to design nonlinear models of dynamical systems with desired (exponential or power law) relaxation properties.Comment: 17 pages, 6 figure

Management learning at the speed of life:Designing reflective, creative, and collaborative spaces for millenials

This paper introduces the concept of "management learning at the speed of life" as a metaphor to inspire millenials. Millenials may face three major problems in relation to management learning: lack of concentration, lack of engagement, and lack of socialization. Management learning at the speed of life addresses these potential problems through three dimensions: reflective, creative, and collaborative learning. This paper illustrates the benefits of reflective, creative, and collaborative spaces for millenials using practices from leadership and personal development courses that were offered over seven years in Canada, Turkey, and the UK. These courses incorporated the latest technology that brought the course activities up to the speed of life

Plant toxin levels in nectar vary spatially across native and introduced populations

1. Secondary compounds in nectar may function as toxic chemical defences and regulate floral antagonists, but can also mediate plant-pollinator interactions. Despite their ecological importance, few studies have investigated the patterns, causes and consequences of spatial variation in toxic nectar compounds in plant species, and none outside their native range. 2. Grayanotoxin I (GTX I) occurs in nectar of invasive Rhododendron ponticum where it is toxic to honeybees and some solitary bee species. We examined (i) geographic variation in the composition of nectar GTX I and GTX III (which is not toxic to these species) in the native and introduced range of R. ponticum, (ii) how their expression is structured at patch and landscape scales within ranges, and (iii) if climatic and environmental factors underpin spatial patterns. 3. While both GTXs varied within ranges, variation in GTX I, but not GTX III, was detected between ranges. GTX I expression was thus markedly lower or (in 18% of cases) absent from nectar in introduced plants. Spatial autocorrelation was apparent at both patch and landscape scales, and in part related to heat load interception by plants (a function of latitude, aspect and slope) 4. As expression of nectar GTXs was generally robust to environmental variation, and aggregated in space, this trait has the potential to be spatially discriminated by consumers. Given the specificity of change to GTX I, and its differential toxicity to some bee species, we conclude that its expression was likely influenced during invasion by pollinator-mediated selection and/or enemy-release from floral antagonists. 5. Synthesis. As the first demonstration of large-scale geographic variation and spatial structure in toxic nectar compounds, this work deepens our understanding of the chemical ecology of floral interactions in native and introduced species. Spatially explicit studies of nectar secondary compounds are thus required to show how the extent and structure of spatial variation may affect floral ecology. Future development of invasion theory should incorporate a holistic view of plant chemical defence, beyond antagonistic interactions, which integrates the consequences of chemically defended mutualist rewards

Cutting the research pie: a value-weighting approach to explore perceptions about psychosocial research priorities for adults with haematological cancers

Despite the burden of illness associated with haematological cancers, little research is available about improving psychosocial outcomes for this group. Given scarce research funds, it is important to ensure that resources are used strategically for improving their psychosocial well-being. This study aimed to identify the perceptions of professionals, patients and carers regarding prioritising psychosocial research efforts. First, an expert panel's views on priorities for research were identified. This was followed by a web survey to obtain the perceptions of 117 health professionals, patients and carers. The value-weighting survey used points allocation, allowing respondents to indicate the relative priority of each option. A substantial proportion of resources were allocated to patients who were newly diagnosed or receiving treatment. Less priority was given to other stages of the cancer journey or non-patient populations. There was no indication that any type of psychosocial research was a priority; however, some differences were identified when comparing the priorities of the three respondent groups. To improve psychosocial outcomes for haematological cancer patients, resources should be directed towards patients in the early stages of the cancer journey. There may be a need for research investigating potential interventions to improve psychosocial outcomes for patients with haematological cancers

Control of COVID-19 Outbreaks under Stochastic Community Dynamics, Bimodality, or Limited Vaccination

Reaching population immunity against COVID-19 is proving difficult even in countries with high vaccination levels. Thus, it is critical to identify limits of control and effective measures against future outbreaks. The effects of nonpharmaceutical interventions (NPIs) and vaccination strategies are analyzed with a detailed community-specific agent-based model (ABM). The authors demonstrate that the threshold for population immunity is not a unique number, but depends on the vaccination strategy. Prioritizing highly interactive people diminishes the risk for an infection wave, while prioritizing the elderly minimizes fatalities when vaccinations are low. Control over COVID-19 outbreaks requires adaptive combination of NPIs and targeted vaccination, exemplified for Germany for January–September 2021. Bimodality emerges from the heterogeneity and stochasticity of community-specific human–human interactions and infection networks, which can render the effects of limited NPIs uncertain. The authors' simulation platform can process and analyze dynamic COVID-19 epidemiological situations in diverse communities worldwide to predict pathways to population immunity even with limited vaccination.Peer Reviewe