Daily adaptive radiotherapy for patients with prostate cancer using a high field MR-linac: Initial clinical experiences and assessment of delivered doses compared to a C-arm linac.

Introduction:MR-guided adapted radiotherapy (MRgART) using a high field MR-linac has recently become available. We report the estimated delivered fractional dose of the first five prostate cancer patients treated at our centre using MRgART and compare this to C-Arm linac daily Image Guided Radiotherapy (IGRT). Methods:Patients were treated using adapted treatment plans shaped to their daily anatomy. The treatments were recalculated on an MR image acquired immediately prior to treatment delivery in order to estimate the delivered fractional dose. C-arm linac non-adapted VMAT treatment plans were recalculated on the same MR images to estimate the fractional dose that would have been delivered using conventional radiotherapy techniques using a daily IGRT protocol. Results:95% and 93% of mandatory target coverage objectives and organ at risk dose constraints were achieved by MRgART and C-arm linac delivered dose estimates, respectively. Both delivery techniques were estimated to have achieved 98% of mandatory Organ At Risk (OAR) dose constraints whereas for the target clinical goals, 86% and 80% were achieved by MRgART and C-arm linac delivered dose estimates. Conclusions:Prostate MRgART can be delivered using the a high field MR-linac. Radiotherapy performed on a C-arm linac offers a good solution for prostate cancer patients who present with favourable anatomy at the time of reference imaging and demonstrate stable anatomy throughout the course of their treatment. For patients with critical OARs abutting target volumes on their reference image we have demonstrated the potential for a target dose coverage improvement for MRgART compared to C-arm linac treatment

Stress System Dynamics during “Life As It Is Lived”: An Integrative Single-Case Study on a Healthy Woman

Little is known about the dynamic characteristics of stress system activity during “life as it is lived”. Using as representative a study design as possible, this investigation sought to gain insights into this area. A healthy 25-year-old woman collected her entire urine over a period of 63 days in 12-h intervals (126 measurements) to determine cortisol and neopterin (immune activation marker) levels. In addition, she filled out questionnaires on emotional state and daily routine in 12-h intervals, and was interviewed weekly to identify emotionally negative and positive everyday incidents. Adjusted cross-correlational analyses revealed that stressful incidents were associated with cyclic response patterns in both urinary cortisol and urinary neopterin concentrations. Urinary cortisol levels first decreased 12–24 h after stressful incidents occurred (lag 1: −.178; p = 0.048) and then increased a total of 72–84 h later (lag 6: +.224; p = 0.013). Urinary neopterin levels first increased 0–12 h before the occurrence of stressful incidents (−lag 1: +.185; p = 0.040) and then decreased a total of 48–60 h following such stressors (lag 4: −.181; p = 0.044). Decreases in urinary neopterin levels were also found 24–36 and 48–60 h after increases in pensiveness (lag 2: −.215; p = 0.017) and depressiveness (lag 4: −.221; p = 0.014), respectively. Findings on emotionally positive incidents sharply contrasted with those dealing with negative experiences. Positive incidents were followed first by urinary cortisol concentration increases within 12 h (lag 0: +.290; p = 0.001) and then by decreases after a total of 60–72 h (lag 5: −.186; p = 0.039). Urinary neopterin levels first decreased 12–24 h before positive incidents occurred (−lag 2: −.233; p = 0.010) and then increased a total of 12–24 h following these incidents (lag 1: +.222; p = 0.014). As with previous investigations on patients with systemic lupus erythematosus (SLE), this study showed that stress system response can be considerably longer and more complex and differentiated than findings from conventional group studies have suggested. Further integrative single-case studies will need to be conducted in order to draw firm conclusions about stress system dynamics under real-life conditions

Early smoking in school-aged children with and without a diagnosis of asthma

Item does not contain fulltextBackground: Research has shown that adolescents with asthma are as likely as and sometimes even more likely to smoke than their peers without asthma. The current study examined whether the prevalence of the first active smoking experience differs for children (9-12 years of age) diagnosed with asthma compared with children who do not have asthma. The association between asthma and smoking was evaluated with logistic regression analysis, controlling for socio-economic status, parental smoking and child's internalizing and externalizing behaviours. Method: A nation-wide sample of 1476 mother and child dyads participated, of which 220 children (14.9%) had been diagnosed with childhood asthma. Results: Children diagnosed with asthma were 2.45 times more likely to have taken a puff of a cigarette compared with children without asthma. In addition, the association between asthma and early smoking remained significant after including potential confounders in the regression equation. Discussion: Suggestions are provided for preventing school-aged children, especially youths with asthma, from smoking. Additional research is needed to gain further insights into the mechanisms underlying the higher likelihood of early smoking among children with asthma

Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer.

Whole bladder magnetic resonance image-guided radiotherapy using the 1.5 Telsa MR-linac is feasible. Full online adaptive planning workflow based on the anatomy seen at each fraction was performed. This was delivered within 45 min. Intra-fraction bladder filling did not compromise target coverage. Patients reported acceptable tolerance of treatment

Older people and transitions from employment to nonemployment : international perspectives and policy issues

The Organization for Economic Co-operation and Development (OECD) has identified population aging as one of the most important challenges facing OECD countries and has highlighted the need for people to work longer and for job prospects for older workers to be enhanced. This article provides a summary review of a recent OECD report, Ageing and Employment Policies—Live Longer, Work Longer, as a platform to highlight differences between countries in demographic profiles and projections and in patterns of formal labor market participation among older workers. Drawing on selected information from a broader evidence base, it unveils important differences between countries in the scale of demographic and associated labor market challenges. It also explores factors affecting labor market transitions among older workers and age-related and other barriers to paid work among older people, emphasizing the diversity of experience between individuals. Finally, it highlights some strategic challenges for policy