Prevalence of patientreported gastrointestinal symptoms and agreement with clinician toxicity assessments in radiation therapy for anal cancer.

Purpose Gastrointestinal (GI) symptoms pose a significant burden to patients receiving chemoradiation therapy (CRT) for anal cancer; however, the impact of symptoms from the patient perspective has not been quantified. This retrospective study examined and compared patient and clinician reports of acute GI toxicity during CRT. Materials and methods Patients treated with definitive RT using intensity-modulated radiation therapy for anal cancer between 9/09 and 11/12 were reviewed. Median RT dose was 56 Gy (range 45–56), and 76 patients (97%) received concurrent 5-fluorouracil-based chemotherapy. During RT, patients completed the 7-item Bowel Problem Scale (BPS) weekly. Clinicians assessed toxicity separately using CTCAE v. 3.0. Scores of BPS C 3 and CTCAE C 1 were considered to be clinically meaningful. Agreement of the two assessments was evaluated by Cohen’s kappa coefficient. Results Seventy-eight patients completed at least one BPS and had a corresponding clinician assessment. Patients reporting scores of C3 was highest at week 5 (n = 68) for diarrhea (44.1%), proctitis (57.4%), and mucus (48.4%), while urgency (47.6%), tenesmus (31.7%), and cramping (27%) were highest at week 4 (n = 63). Baseline bleeding scores (26.7%; score C3) improved during treatment (13.4% at week 5). ‘‘Poor’’ agreement was observed between patient- and clinician-reported proctitis (Cohen’s k = 0.11; n = 58); however, there was ‘‘good’’ agreement for diarrhea (Cohen’s k = 0.68; n = 58). Conclusions Acute GI toxicity during definitive CRT for anal cancer was most significant during weeks 4–5, while rectal bleeding improved during treatment. Discrepancies in patient- and clinician-reported symptoms demonstrate the potential for patient-reported outcomes to be useful tools for anal cancer clinical assessments

We Will Rise No Matter What\u27: Community Perspectives of Disaster Resilience Following Hurricanes Irma and Maria In Puerto Rico

Category 4 Hurricane Maria made landfall in Puerto Rico on 20 September 2017 and ploughed across the territory with sustained winds of 155 mph. Just two weeks earlier, category 5 Hurricane Irma had struck the island already damaging critical infrastructure making Hurricane Maria even more devasting. The hurricanes caused catastrophic damage, resulting in the largest and longest response to a domestic disaster in the history of the United States. This paper explores the recovery process in Puerto Rico using a community resilience lens. The study examines narratives, the media environment, trusted sources, and information preferences following the crisis. Community workshops, interviews, and focus groups reveal indicators of resilience in Puerto Rico alongside areas for improvement. Theoretical contributions discuss the role of identity, sense of place, and the impact of culture on community resilience. Practical contributions touch on messaging, acknowledging infrastructure vulnerabilities, and the importance of strengthening community relationships

From Mantle to Motzfeldt : a genetic model for syenite-hosted Ta,Nb-mineralisation

This research summarises many years of field and lab studies on the area, but the most recent work (2016) has received funding from the European Union’s Horizon 2020 research and innovation programme (grant agreement No 689909).A genetic model for the Motzfeldt Tantalum-Niobium-rich syenite in south-west Greenland, considered to be one of the world’s largest Ta prospects, is presented. The Motzfeldt primary magma formed early in regional Gardar (1273 ± 6 Ma) rifting. Isotope signatures indicate that the Hf had multiple sources involving juvenile Gardar Hf mixed with older (Palaeoproterozoic or Archaean) Hf. We infer that other High Field Strength Elements (HFSE) similarly had multiple sources. The magma differentiated in the crust and ascended before emplacement at the regional unconformity between Ketilidian basement and Eriksfjord supracrustals. The HFSE-rich magmas crystallised Ta-rich pyrochlore which formed pyrochlore-rich crystal mushes, and it is these pyrochlore-rich horizons, rich in Ta and Nb, that are the focus of exploration. The roof zone chilled and repeated sheeting at the roof provided a complex suite of cross-cutting syenite variants, including pyrochlore microsyenite, in a ‘Hot Sheeted Roof’ model. The area was subject to hydrothermal alteration which recrystallized alkali feldspar to coarse perthite and modified the mafic minerals to hematite, creating the friable and striking pink-nature of the Motzfeldt Sø Centre. Carbon and oxygen isotope investigation of carbonate constrains fluid evolution and shows that carbonate is primarily mantle-derived but late-stage hydrothermal alteration moved the oxygen isotopes towards more positive values (up to 21‰). The hydrothermal fluid was exceptionally fluorine-rich and mobilised many elements including U and Pb but did not transport HFSE such as Ta, Hf and Nb. Although the U and Pb content of the pyrochlore was enhanced by the fluid, the HFSE contents remained unchanged and therefore Hf isotopes were unaffected by fluid interaction. While the effect on hydrothermal alteration on the visual appearance of the rock is striking, magmatic processes concentrated HFSE including Ta and the hydrothermal phase has not altered the grade. Exploration for HFSE mineralisation commonly relies on airborne radiometric surveying which is particularly sensitive to the presence of U, Th. A crucial lesson from Motzfeldt is that the best target is unaltered pyrochlore which was identified less easily by radiometric survey. Careful petrological/mineral studies are necessary before airborne survey data can be fully interpreted.PreprintPostprintPeer reviewe

Anatomy and Physiology II Lab Materials

This set of lab videos and lessons for Anatomy and Physiology II was created under an ALG Affordable Materials Grant. Lesson topics covered include blood, heart, vessels, digestive system, endocrine system, respiratory system, urinary system, reproductive system, and human development, and videos focus on histology for each topic.https://oer.galileo.usg.edu/biology-textbooks/1025/thumbnail.jp

Anatomy and Physiology I Lab Materials

This set of lab videos and lessons for Anatomy and Physiology I was created under an ALG Affordable Materials Grant. Lesson topics covered include microscopy, cytology, histology, integumentary system, skeletal system, axial skeleton, appendicular skeleton, muscular system, nervous system, and human senses.https://oer.galileo.usg.edu/biology-textbooks/1026/thumbnail.jp

From Mantle to Motzfeldt:a genetic model for syenite-hosted Ta,Nb-mineralisation

A genetic model for the Motzfeldt Tantalum-Niobium-rich syenite in south-west Greenland, considered to be one of the world’s largest Ta prospects, is presented. The Motzfeldt primary magma formed early in regional Gardar (1273 ± 6 Ma) rifting. Isotope signatures indicate that the Hf had multiple sources involving juvenile Gardar Hf mixed with older (Palaeoproterozoic or Archaean) Hf. We infer that other High Field Strength Elements (HFSE) similarly had multiple sources. The magma differentiated in the crust and ascended before emplacement at the regional unconformity between Ketilidian basement and Eriksfjord supracrustals. The HFSE-rich magmas crystallised Ta-rich pyrochlore which formed pyrochlore-rich crystal mushes, and it is these pyrochlore-rich horizons, rich in Ta and Nb, that are the focus of exploration. The roof zone chilled and repeated sheeting at the roof provided a complex suite of cross-cutting syenite variants, including pyrochlore microsyenite, in a ‘Hot Sheeted Roof’ model. The area was subject to hydrothermal alteration which recrystallized alkali feldspar to coarse perthite and modified the mafic minerals to hematite, creating the friable and striking pink-nature of the Motzfeldt Sø Centre. Carbon and oxygen isotope investigation of carbonate constrains fluid evolution and shows that carbonate is primarily mantle-derived but late-stage hydrothermal alteration moved the oxygen isotopes towards more positive values (up to 21‰). The hydrothermal fluid was exceptionally fluorine-rich and mobilised many elements including U and Pb but did not transport HFSE such as Ta, Hf and Nb. Although the U and Pb content of the pyrochlore was enhanced by the fluid, the HFSE contents remained unchanged and therefore Hf isotopes were unaffected by fluid interaction. While the effect on hydrothermal alteration on the visual appearance of the rock is striking, magmatic processes concentrated HFSE including Ta and the hydrothermal phase has not altered the grade. Exploration for HFSE mineralisation commonly relies on airborne radiometric surveying which is particularly sensitive to the presence of U, Th. A crucial lesson from Motzfeldt is that the best target is unaltered pyrochlore which was identified less easily by radiometric survey. Careful petrological/mineral studies are necessary before airborne survey data can be fully interpreted

Predictors of acute toxicities during definitive chemoradiation using intensity-modulated radiotherapy for anal squamous cell carcinoma

<p><b>Purpose.</b> To identify clinical and dosimetric factors associated with acute hematologic and gastrointestinal (GI) toxicities during definitive therapy using intensity-modulated radiotherapy (IMRT) for anal squamous cell carcinoma (ASCC).</p> <p><b>Materials and methods.</b> We retrospectively analyzed 108 ASCC patients treated with IMRT. Clinical information included age, gender, stage, concurrent chemotherapy, mitomycin (MMC) chemotherapy and weekly hematologic and GI toxicity during IMRT. From contours of the bony pelvis and bowel, dose-volume parameters were extracted. Logistic regression models were used to test associations between toxicities and clinical or dosimetric predictors.</p> <p><b>Results.</b> The median age was 59 years, 81 patients were women and 84 patients received concurrent MMC and 5-fluorouracil (5FU). On multivariate analysis (MVA), the model most predictive of Grade 2 + anemia included the maximum bony pelvis dose (Dmax), female gender, and T stage [p = 0.035, cross validation area under the curve (cvAUC) = 0.66]. The strongest model of Grade 2 + leukopenia included V10 (percentage of pelvic bone volume receiving ≥ 10 Gy) and number of MMC cycles (p = 0.276, cvAUC = 0.57). The model including MMC cycle number and T stage correlated best with Grade 2 + neutropenia (p = 0.306, cvAUC = 0.57). The model predictive of combined Grade 2 + hematologic toxicity (HT) included V10 and T stage (p = 0.016, cvAUC = 0.66). A model including VA45 (absolute bowel volume receiving ≥ 45 Gy) and MOH5 (mean dose to hottest 5% of bowel volume) best predicted diarrhea (p = 0.517, cvAUC = 0.56).</p> <p><b>Conclusion.</b> Dosimetric constraints to the pelvic bones should be integrated into IMRT planning to reduce toxicity, potentially reducing treatment interruptions and improving disease outcomes in ASCC. Specifically, our results indicate that Dmax should be confined to ≤ 57 Gy to minimize anemia and that V10 should be restricted to ≤ 87% to reduce incidence of all HT.</p