Radiation-induced cardiac side-effects:The lung as target for interacting damage and intervention

Radiotherapy is part of the treatment for many thoracic cancers. During this treatment heart and lung tissue can often receive considerable doses of radiation. Doses to the heart can potentially lead to cardiac effects such as pericarditis and myocardial fibrosis. Common side effects after lung irradiation are pneumonitis and pulmonary fibrosis. It has also been shown that lung irradiation has effects on cardiac function. In a rat model lung irradiation caused remodeling of the pulmonary vasculature increasing resistance of the pulmonary vascular bed, leading to enhanced pulmonary artery pressure, right ventricle hypertrophy and reduced right ventricle performance. Even more pronounced effects are observed when both, lung and heart are irradiated. The effects observed after lung irradiation show striking similarities with symptoms of pulmonary arterial hypertension. In particular, the vascular remodeling in lung tissue seems to have similar underlying features. Here, we discuss the similarities and differences of vascular remodeling observed after thoracic irradiation compared to those in pulmonary arterial hypertension patients and research models. We will also assess how this knowledge of similarities could potentially be translated into interventions which would be beneficial for patients treated for thoracic tumors, where dose to lung tissue is often unavoidable

Radiation-induced cardiac side-effects: The lung as target for interacting damage and intervention

Radiotherapy is part of the treatment for many thoracic cancers. During this treatment heart and lung tissue can often receive considerable doses of radiation. Doses to the heart can potentially lead to cardiac effects such as pericarditis and myocardial fibrosis. Common side effects after lung irradiation are pneumonitis and pulmonary fibrosis. It has also been shown that lung irradiation has effects on cardiac function. In a rat model lung irradiation caused remodeling of the pulmonary vasculature increasing resistance of the pulmonary vascular bed, leading to enhanced pulmonary artery pressure, right ventricle hypertrophy and reduced right ventricle performance. Even more pronounced effects are observed when both, lung and heart are irradiated.The effects observed after lung irradiation show striking similarities with symptoms of pulmonary arterial hypertension. In particular, the vascular remodeling in lung tissue seems to have similar underlying features. Here, we discuss the similarities and differences of vascular remodeling observed after thoracic irradiation compared to those in pulmonary arterial hypertension patients and research models. We will also assess how this knowledge of similarities could potentially be translated into interventions which would be beneficial for patients treated for thoracic tumors, where dose to lung tissue is often unavoidable

Strategizing as multi-modal and rhetorical discursive practice: a case study of the BHP Billiton's failed acquisition of Rio Tinto

This thesis took a discourse approach to analyze BHP Billiton’s failed acquisition of Rio Tinto in 2007-08 to better understand what happens during strategizing. The research highlighted the structure and dynamics of the discourse, as well as the role of time and context in the social construction of meaning in strategizing. In doing so, the thesis provided new insights into how actors were able to influence such important strategic events. The thesis adopted a multi-modal discourse analytic framework and analyzed media reports, corporate videos, press releases and communications to shareholders, as well as slides and full transcripts of key presentations by both BHP and Rio leadership. The analysis identified the main internal and external actors as either decision-makers (BHP’s leadership, shareholders, competition regulators) or influencers (Rio’s leadership, analysts, media, customers). It further identified a range of multi-modal discursive practices and rhetorical strategies that were brought to bear to negotiate the meaning of three key constructs that shaped the discourse, that is, the additional value pool, the fair share exchange ratio, and the impact on competition. Further, the findings showed how time and context were discursively constructed and influenced the meaning of the three key constructs. These findings enabled a number of contributions to the discourse and M&A literature. While most research into acquisition discourses has routinely ignored the pre-acquisition discourse, this thesis focused on the period preceding the transaction. An initial contribution was to show that, in a pre-acquisition discourse, external actors were not a passive audience but played a significant role as rhetor and audience. Also, while previous empirical studies of discourse have emphasized the role of language, this thesis considered multi-modal discursive practices, including speech, writing, imagery, location and calculative devices. The thesis made a further contribution by showing how actors worked to persuade each other through multi-layered rhetorical strategies that were also brought to bear through non-linguistic modes. This contribution was extended by showing how these practices functioned as transgression markers that signaled convergence or divergence of meaning of the key constructs. A detailed analysis of calculative devices enabled further contributions. An initial contribution was that it showed how calculative devices developed as boundary objects over four stages: identification, calculation, negotiation, and objectification. Further, the thesis showed how calculative devices were imbued with logos and ethos through, for example, the calculative logic, accounting standards and data sources that were woven together in the symbolic manipulations of the device. Lastly, the thesis showed how calculative devices acted as boundary objects, and made a contribution to theory by proposing a third criterion, legitimacy, to complement widely acknowledged criteria of adaptability and commonality. In addition to these dynamics, the thesis outlined a discursive epistemology of strategizing through its analysis of the role of time and context in the social construction of meaning in strategizing. While the role of time and context is widely acknowledged in organizational discourse, it remained unclear what was specific to strategizing. The thesis argued that the purpose of strategizing is to construct and negotiate new or improved options for a preferred future and the actions to bring this about, and made a contribution to a discursive epistemology of strategizing by showing how temporal and contextual work in strategizing extends the horizon of discourses that relate to the future and discourses that relate to the broader discourse. This reconstructs the tapestry of interwoven discourses that make up the local strategy discourse, and creates new strategic options

Recurrent scoliosis one year after surgical correction

A year after anterolateral spondylodesis for progressive scoliosis, the patient showed a flexion gait pattern with recurrent deformity, due to late infection. Surgical debridement resolved all symptoms. Whereas most postoperative infections occur after posterior spondylodesis and present with back pain and mild increase of infection parameters, late infection after anterolateral approach is rare. In this case the patient did not present with the classic symptoms

Child Maltreatment in Families Receiving Mandatory Versus Voluntary Child Protection Support:A Matched Cohort Study

Child safety is an important outcome of child protection services (CPSs); however, this is often assessed in terms of official registries (e.g., rereports). Little empirical evidence is available about how the frequency of child maltreatment changes during CPS intervention by using self-report measures. The present study evaluates the frequency of child maltreatment experienced by children receiving mandatory child protection support compared to carefully matched children receiving voluntary child protection support. The current study is part of an ongoing Dutch longitudinal study on family violence consisting of several cohorts with similar designs. Both parents and children reported on the frequency of child maltreatment using validated questionnaires at two timepoints, 12 months apart. To facilitate careful comparison, both groups were matched using propensity scores based on background variables, resulting in two groups of N = 178 children. GLMM analyses showed a significant decrease in the mean number of child maltreatment incidents over time in the total group. However, this decrease did not differ for children receiving mandatory and voluntary child protection support. The findings indicate that, despite possible motivational challenges in the mandatory group, mandatory child protection support elicits comparable results as voluntary support. Implications for further research and practice are discussed.</p

Child Maltreatment in Families Receiving Mandatory Versus Voluntary Child Protection Support:A Matched Cohort Study

Child safety is an important outcome of child protection services (CPSs); however, this is often assessed in terms of official registries (e.g., rereports). Little empirical evidence is available about how the frequency of child maltreatment changes during CPS intervention by using self-report measures. The present study evaluates the frequency of child maltreatment experienced by children receiving mandatory child protection support compared to carefully matched children receiving voluntary child protection support. The current study is part of an ongoing Dutch longitudinal study on family violence consisting of several cohorts with similar designs. Both parents and children reported on the frequency of child maltreatment using validated questionnaires at two timepoints, 12 months apart. To facilitate careful comparison, both groups were matched using propensity scores based on background variables, resulting in two groups of N = 178 children. GLMM analyses showed a significant decrease in the mean number of child maltreatment incidents over time in the total group. However, this decrease did not differ for children receiving mandatory and voluntary child protection support. The findings indicate that, despite possible motivational challenges in the mandatory group, mandatory child protection support elicits comparable results as voluntary support. Implications for further research and practice are discussed.</p

A new CT-based method to quantify radiation-induced lung damage in patients

SummaryA new method to assess radiation-induced lung toxicity (RILT) using CT-scans was developed. It is more sensitive in detecting damage and corresponds better to physician-rated radiation pneumonitis than routinely-used methods. Use of this method may improve lung toxicity assessment and thereby facilitate development of more accurate predictive models for RILT