Shared consumption is proposed as a comparably sustainable consumption practice. However, little is known about effects of shared consumption on individuals. We build on the theory of planned ...behavior and the value-belief-norm theory using cross-lagged structural equation modeling based on a two-wave panel study with 168 consumers to examine the effects a shared consumption pattern has on consumers' values, attitudes, and norms. Our structural model explains a medium to large amount of variance in self-reported shared consumption. We find shared consumption has statistically significant positive cross-lagged effects on future altruistic values, attitudes, subjective norms, and personal norms. However, no statistically significant effects of shared consumption are found on consumers' future biospheric and egoistic values. Thus, the more consumers engaged in shared consumption, the more concerned they were for others, while it did not affect their concern for the environment or themselves. Theoretical and practical implications of our results are discussed.
•We examine the effects of shared consumption on consumers' values, attitudes, and norms.•Consumers engaging in shared consumption keep favorable attitudes and norms toward it.•Engaging in shared consumption increases consumers' altruistic concern for others.•Engaging in shared consumption does not affect consumers' concern for the environment or themselves.
To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the ...2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time.
A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey.
Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments.
An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.
Stereotactic radiosurgery (SRS) is the preferred treatment for vestibular schwannoma (VS) in patients with preserved hearing and tumour diameter < 3 cm. Emerging evidence suggests restricting ...cochlear dose could preserve hearing. This retrospective replanning study aims to compare dynamic conformal arc therapy (DCAT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for superiority of cochlear dose sparing without compromising tumour coverage.
Eligibility criteria included sporadic VS, serviceable hearing and availability of CT and MRI for planning. The original gross tumour volume and brainstem OAR volume were retained; the cochlea was newly contoured on the planning CT scan (bone window). Each case was replanned using the three above techniques, prescribing 12 Gy to the 80% isodose line. No dose constraint was applied to the cochlea.
Eighteen patients were replanned. Mean tumour volume was 2.25 cc. Tumour coverage and tumour mean dose (DCAT: 14.2, IMRT: 14.6, VMAT: 14.5 Gy) were comparable. Paddick and RTOG conformity indices were better for DCAT (0.66 and 1.6) and VMAT (0.69 and 1.5) compared to IMRT (0.56 and 1.9). DCAT had superior gradient index (3.0) compared to VMAT (3.4) and IMRT (3.4). VMAT delivered the lowest mean brainstem maximum dose (8.3 Gy) and decreased the mean cochlear dose (3.4 Gy) by 2.3 and 2.1 Gy, and the mean cochlear maximum dose (3.6 Gy) by 2.4 and 2.5 Gy relative to DCAT and IMRT, respectively.
LINAC-based SRS treatment using VMAT can achieve better cochlear dose sparing than DCAT or IMRT while maintaining tumour coverage.
Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according ...to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice.
The members of three global radiation oncology professional organizations (American Society for Radiology Oncology ASTRO, Canadian Association of Radiation Oncology CARO, Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy.
A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status.
Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of previous randomized controlled trials. Our results have confirmed a delay in the incorporation of evidence into practice for palliative radiotherapy for painful bone metastases.
In Regard to Renz et al Roos, Daniel E; Smith, Jennifer G
International journal of radiation oncology, biology, physics,
03/2019, Letnik:
103, Številka:
4
Journal Article
Summary Background Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose ...fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy. Methods We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide. We enrolled patients 18 years or older who had radiologically confirmed, painful (ie, pain measured as ≥2 points using the Brief Pain Inventory) bone metastases, had received previous radiation therapy, and were taking a stable dose and schedule of pain-relieving drugs (if prescribed). Patients were randomly assigned (1:1) to receive either 8 Gy in a single fraction or 20 Gy in multiple fractions by a central computer-generated allocation sequence using dynamic minimisation to conceal assignment, stratified by previous radiation fraction schedule, response to initial radiation, and treatment centre. Patients, caregivers, and investigators were not masked to treatment allocation. The primary endpoint was overall pain response at 2 months, which was defined as the sum of complete and partial pain responses to treatment, assessed using both Brief Pain Inventory scores and changes in analgesic consumption. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov , number NCT00080912. Findings Between Jan 7, 2004, and May 24, 2012, we randomly assigned 425 patients to each treatment group. 19 (4%) patients in the 8 Gy group and 12 (3%) in the 20 Gy group were found to be ineligible after randomisation, and 140 (33%) and 132 (31%) patients, respectively, were not assessable at 2 months and were counted as missing data in the intention-to-treat analysis. In the intention-to-treat population, 118 (28%) patients allocated to 8 Gy treatment and 135 (32%) allocated to 20 Gy treatment had an overall pain response to treatment (p=0·21; response difference of 4·00% upper limit of the 95% CI 9·2, less than the prespecified non-inferiority margin of 10%). In the per-protocol population, 116 (45%) of 258 patients and 134 (51%) of 263 patients, respectively, had an overall pain response to treatment (p=0·17; response difference 6·00% upper limit of the 95% CI 13·2, greater than the prespecified non-inferiority margin of 10%). The most frequently reported acute radiation-related toxicities at 14 days were lack of appetite (201 56% of 358 assessable patients who received 8 Gy vs 229 66% of 349 assessable patients who received 20 Gy; p=0·011) and diarrhoea (81 23% of 357 vs 108 31% of 349; p=0·018). Pathological fractures occurred in 30 (7%) of 425 patients assigned to 8 Gy and 20 (5%) of 425 assigned to 20 Gy (odds ratio OR 1·54, 95% CI 0·85–2·75; p=0·15), and spinal cord or cauda equina compressions were reported in seven (2%) of 425 versus two (<1%) of 425, respectively (OR 3·54, 95% CI 0·73–17·15; p=0·094). Interpretation In patients with painful bone metastases requiring repeat radiation therapy, treatment with 8 Gy in a single fraction seems to be non-inferior and less toxic than 20 Gy in multiple fractions; however, as findings were not robust in a per-protocol analysis, trade-offs between efficacy and toxicity might exist. Funding Canadian Cancer Society Research Institute, US National Cancer Institute, Cancer Council Australia, Royal Adelaide Hospital, Dutch Cancer Society, and Assistance Publique-Hôpitaux de Paris.
This research investigated the removal of heavy metals (As, Pb, Cr, Cd, Ni, Cu, Fe, and Zn) via batch adsorption process from industrial electroplating wastewater using two different nano-adsorbents; ...purified carbon nanotubes (P-CNTs) and polyhydroxylbutyrate functionalized carbon nanotubes (PHB-CNTs), both produced through catalytic chemical vapour deposition (CCVD) method. HRSEM, HRTEM, XRD, DLS, BET, FTIR, XPS, TGA, pH drift and Raman spectroscopy were used to characterize the developed nano-adsorbents. In the batch adsorption process, the effects of contact time, dosage, temperature and pH were studied. Both nano-adsorbents gave optimum contact time, equilibrium time, optimum dosage, and pH of 10 minutes, 70 minutes, 20 mg, and 5.63-5.65 respectively. The heavy metals removal efficiencies by the nano-adsorbents followed the order of PHB-CNTs > P-CNTs based on ion exchange and electrostatic forces mechanism. For P-CNTs and PHB-CNTs, the equilibrium sorption isotherm suits temkin model, kinetic data fitted to pseudo-second order based on the linear regression correlation coefficient, and the thermodynamic study established spontaneity and endothermic nature of the adsorption process. The findings in this research conclude that both nano-adsorbents have exceptional capacity to remove heavy metals from the adsorbate, with PHB-CNTs possessing better quality. The treated adsorbate meets the standard for industrial or irrigation re-use.
Isolated pulmonary oligometastases as the first site of dissemination after initial resection of pancreatic ductal adenocarcinoma (PC) is a rare event, and the treatment in this subgroup is ...challenging. Recurrence in the lung after initial primary tumour resection is associated with the most long-term survivors of patients with metastatic PC. Stereotactic ablative body radiation therapy (SABR) or metastectomy for pulmonary oligometastases from PC is becoming more common. However, patients with close or positive margins after metastectomy for isolated pulmonary metastatic PC are at high risk for recurrence. This requires a treatment capable of achieving high rates of local control and improved quality of life by delaying the need for systemic chemotherapy. In other settings, SABR has been shown to achieve these goals, allowing safe dose escalation with excellent conformity and short duration of treatment.
We report the case of a 48-year old Caucasian man with a history of locally advanced PC initially treated with neoadjuvant chemotherapy followed by Whipple's resection in August 2016. After a disease-free interval of 3 years, he developed three isolated pulmonary metastases which were treated with local resection. In the setting of microscopically positive resection margins (R1), adjuvant lung SABR was delivered to all three sites. His treated lung disease remained radiologically stable for up to twenty months after SABR. Treatment was well tolerated. In January 2021, he developed a malignant pre-tracheal node which was treated with conventionally fractionated radiotherapy and remained controlled for the duration of follow-up. A year later, he developed widespread metastatic disease including pleura, bone and adrenal gland, together with presumed progression in one of the original lung lesions, receiving palliative radiotherapy for right chest wall pain. He was later found to have an intracranial metastasis and died in February 2022, 5½ years after initial treatment.
We present the case of a patient treated with SABR after R1 resection of 3 isolated pulmonary metastases from PC, with no treatment toxicities and durable local control. For well-selected patients in this setting, adjuvant lung SABR may be a safe and effective treatment option.
The efficient removal of toxic metals ions from chemical industry wastewater is considered problematic due to the existence of pollutants as mixtures in the aqueous matrix, thus development of ...advanced and effective treatment method has been identified as a panacea to the lingering problems of heavy metal pollution. In this study, KIAgNPs decorated MWCNTs nano adsorbent was developed using combination of green chemistry protocol and chemical vapor deposition techniques and subsequently characterized using UV-Vis, HRTEM, HRSEM, XRD, FTIR and XPS. The adsorptive efficiency of MWCNTs-KIAgNPs for the removal of Cr(VI), Ni(II), Fe(II), Cd(II) and physico-chemical parameters like pH, TDS, COD, BOD, nitrates, sulphates, chlorides and phosphates from chemical industrial wastewater was examined in both batch and fixed bed systems. The result exhibited successful deposition of KIAgNPs on the surface of MWCNTs as confirmed by the microstructures, morphology, crystalline nature, functional groups and elemental characteristics of the MWCNTs-KIAgNPs. Optimum batch adsorption parameters include; pH (3 for Cr(VI) and 6 for Ni(II), Fe(II) and Cd(II) ions), contact time (60 min), adsorbent dosage (40 mg) and temperature (318 K). The binding capacities were obtained as follows; Cr
(229.540 mg/g), Ni
(174.784 mg/g), Fe
(149.552) and Cd
(121.026 mg/g), respectively. Langmuir isotherm and pseudo-second order kinetic model best described the experimental data in batch adsorption, while the thermodynamic parameters validated the chemisorption and endothermic nature of the adsorption process. In continuous adsorption, the metal ions were effectively removed at low metal influent concentration, low flow rate and high bed depth, whereby the experimental data were designated by Thomas model. The high physico-chemical parameters in the wastewater were successfully treated in both batch and fixed bed systems to fall within WHO permissible concentrations. The adsorption/desorption study illustrated over 80% metal removal by MWCNTs-KIAgNPs even after 8th adsorption cycle. This study demonstrated excellent performance of MWCNTs-KIAgNPs for chemical industry wastewater treatment.
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