Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer

Background: To date, anal cancer patients are treated with radiotherapy to similar volumes despite a marked difference in risk profile based on tumor location and stage. A more individualized approach to delineation of the elective clinical target volume (CTVe) could potentially provide better oncological outcomes as well as improved quality of life. The aim of the present work was to establish Nordic Anal Cancer (NOAC) group guidelines for delineation of the CTVe in anal cancer.Methods: First, 12 radiation oncologists reviewed the literature in one of the following four areas: (1) previous delineation guidelines; (2) patterns of recurrence; (3) anatomical studies; (4) common iliac and para-aortic recurrences and delineation guidelines. Second, areas of controversy were identified and discussed with the aim of reaching consensus.Results: We present consensus-based recommendations for CTVe delineation in anal cancer regarding (a) which regions to include, and (b) how the regions should be delineated. Some of our recommendations deviate from current international guidelines. For instance, the posterolateral part of the inguinal region is excluded, decreasing the volume of irradiated normal tissue. For the external iliac region and the cranial border of the CTVe, we agreed on specifying two different recommendations, both considered acceptable. One of these recommendations is novel and risk-adapted; the external iliac region is omitted for low-risk patients, and several different cranial borders are used depending on the individual level of risk.Conclusion: We present NOAC consensus guidelines for delineation of the CTVe in anal cancer, including a risk-adapted strategy.Peer reviewe

Numerical simulations of blast loaded steel plates for improved vehicle protection

In the past decade, there has been an increasing demand from governments for high level protections for military vehicles against explosives. However, the design and validation of protection is a time consuming and expensive process, where previous experience plays an important role. Development time and weight are the driving factors, where the weight influences vehicle performance. Numerical simulations are used as a tool in the design process, in order to reduce development time and successively improve the protection. The explosive load acting on a structure is sometimes described with analytical functions, with limitations to shape and type of the explosive, confinement conditions etc. An alternative way to describe the blast load is to use numerical simulations based on continuum mechanics. The blast load is determined by modelling the actual type and shape of the explosive in air or soil, where the explosive force transfers to the structure of interest. However, accuracy of the solution must be considered, where methods and models should be validated against experimental data. Within this work, tests with explosive placed in air, soil or a steel pot have been performed, where the blast load acts on steel target plates resulting in large deformations up to fracture. For the non-fractured target plates, the maximum dynamic and residual deformations of steel plates were measured, while the impulse transfer was measured in some tests. This thesis focuses on continuum based numerical simulations for describing the blast load, with validation against data from the experiments. The numerical and experimental results regarding structural deformation of blast loaded steel plates correlates relatively well against each other. Further, simulations regarding fracture of blast loaded steel plates show conservative results compared to experimental observations. However, more work needs to be undertaken regarding numerical methods to predict fracture on blast loaded structures. The main conclusion of this work is that numerical simulations of blast loading on steel plates, leading to large deformations up to fracture, can be described with sufficient accuracy for design purposes.Godkänd; 2013; 20130318 (bjozak); Tillkännagivande disputation 2013-04-02 Nedanstående person kommer att disputera för avläggande av teknologie doktorsexamen. Namn: Björn Zakrisson Ämne: Hållfasthetslära/Solid Mechanics Avhandling: Numerical simulations of blast loaded steel plates for improved vehicle protection Opponent: Professor Gerald Nurick, Department of Mechanical Engineering, University of Cape Town, South Africa Ordförande: Professor Hans-Åke Häggblad, Institutionen för teknikvetenskap och matematik, Luleå tekniska universitet Tid: Torsdag den 18 april 2013, kl 09.00 Plats: E231, Luleå tekniska universite

Simulering av sprängverkan med finita elementmetoden

Validerat; 20101217 (root

Numerical and experimental studies of blast loading

In the past decade, there has been an increasing demand from governments for high level protections for military vehicles against explosives. However, designing and validation of protection is a time consuming and expensive process, where previous experience plays an important role. Development time and weight are the driving factors, where the weight influences vehicle performance. Numerical simulations are used as a tool in the design process, in order to reduce development time and optimise the protection. The explosive load acting on a structure is sometimes described with analytical functions, with limitations to shape and type of the explosive, confinement conditions etc. An alternative way to describe the blast load is to use numerical simulations based on continuum mechanics. The blast load is determined by modelling the actual type and shape of the explosive in air or sand, where the explosive force transfers to the structure of interest. However, accuracy of the solution must be considered, were methods and models should be validated against reliable experimental data. Within this work, tests with explosive placed in air, sand or a steel pot has been performed. For all tests, the dynamic and residual deformation of steel plates was measured, while the impulse transfer was measured for some tests. This thesis focuses on continuum based numerical simulations for describing the blast load, with validation against data from the experiments. The main conclusion of this work is that numerical simulations of air blast loading in the near-field can be described with sufficient accuracy.Godkänd; 2010; 20100220 (bjozak); LICENTIATSEMINARIUM Ämnesområde: Hållfasthetslära/Solid Mechanics Examinator: Professor Hans-Åke Häggblad, Luleå tekniska universitet Tid: Fredag den 26 mars 2010 kl 13.00 Plats: E 231, Luleå tekniska universite

Modelling and simulation of explosions in sand

Godkänd; 2011; 20111214 (bjozak

One additional educational session in inhaler use to patients with COPD in primary health care - A controlled clinical trial

Objective: To investigate whether one additional educational session about inhaler use, delivered to patients with COPD in primary healthcare, could affect the patients' skills in inhaler use. Specifically, to study the effects on errors related to handling the device, to inhalation technique, and to both. Methods: This nonrandomized controlled clinical trial included 64 patients who used devices and made errors. COPD nurses assessed inhaler use using a checklist and educated patients. Intervention group received one additional educational session after two weeks. Results: At baseline, patients in the IG had more devices (n = 2,1) compared to patients in the CG (n = 1,6) (p = 0.003). No other statistically significant differences were seen at baseline. At follow-up, intervention group showed a lower proportion of patients who made errors related to handling the device (p = 0.006). No differences were seen in the other categories. Conclusion: One additional educational session in inhaler use for patients with COPD was effective in reducing the proportion of patients making errors related to handling of their devices. Practice implications: Categorization of errors might help healthcare professionals to assess the suitability of patients' devices, tailor patient education, and thus improve patient health

Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care

Aim The aim of this study was to describe inhaler use in primary health care patients with chronic obstructive pulmonary disease (COPD) and to categorize these patients into those making errors related to devices, those making errors related to inhalation technique and those making errors related to both. Design Observational study. Methods COPD nurses used a checklist to assess the use of inhalers by patients with spirometry‐verified COPD (N = 183) from primary healthcare centres. The STROBE checklist has been used. Results The mean age of the patients was 71 (SD 9) years. Almost half of them (45%) made at least one error; of these, 50% made errors related to devices, 31% made errors related to inhalation technique and 19% made errors related both to devices and to inhalation technique