BACKGROUNDThe randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). ...Patient-reported outcome (PRO) is the only follow-up measure. Due to the fragile patient population, low respondent compliance was anticipated. We performed a planned interim analysis of dosimetry and respondent compliance, to ensure that the protocol requirements were met.METHODSPatients >18 years referred for cervical/thoracic MSCC radiotherapy in 1-10 fractions were included from two centres. Patients were randomized (1:1) to standard RT or oesophagus-sparing RT, where predefined oesophageal dose constraints were prioritized over target coverage. Patients completed a trial diary with daily reports of dysphagia for 5 weeks (PRO-CTC-AE) and weekly quality of life reports for 9 weeks (QLQ-C30, EQ-5D-5L). According to power calculation, 124 patients are needed for primary endpoint analysis. The sample size was inflated to 200 patients to account for the fragile patient population. The co-primary endpoints, peak patient-reported dysphagia, and preserved ability to walk (EQ-5D-5L), are analysed at 5 and 9 weeks, respectively. The interim analysis was conducted 90 days after the inclusion of patient no 100. Respondent compliance was assessed at 5 and 9 weeks. In all RT plans, oesophagus and target doses were evaluated regarding adherence to protocol constraints.RESULTSFrom May 2021 to November 2022, 100 patients were included. Fifty-two were randomized to oesophagus-sparing RT. In 23% of these plans, oesophagus constraints were violated. Overall, the dose to both target and oesophagus was significantly lower in the oesophagus-sparing plans. Only 51% and 41% of the patients were evaluable for co-primary endpoint analysis at five and nine weeks, respectively. Mortality and hospitalization rates were significantly larger in patients who completed <4 days PRO questionnaires.CONCLUSIONCompliance was lower than anticipated and interventions to maintain study power are needed.
Waldenström macroglobulinemia rarely presents as pulmonary symptoms, and even rarer as chylothorax. We present a patient who presented with bilateral pleural effusion and a 30 mm solid lesion in the ...lung. Biochemical analysis of the pleural fluid revealed chylothorax. The 18-fluorodeoxygenase positron emission tomography, bronchoscopy, endobronchial ultrasound, and cytological examination of the pleural fluid, showed no apparent cause of the chylothorax. The diagnostic breakthrough was made with flow cytometry of the pleural fluid, which revealed a small group of clonal B-cells. Biopsy from the parietal pleura and bone marrow led to the diagnosis Waldenström macroglobulinemia. This demonstrates that flow cytometry should be considered when routine diagnostics do not lead to a reach a specific diagnosis.
Purpose
The purpose of this paper is to analyze price decision-making through a practice-based approach. The paper investigates the micro-level practices used to arrive at sales price decisions.
...Design/methodology/approach
In this study, a qualitative study approach is used to develop findings abductively. The data are gathered through an in-depth case study at two firms: semi-structured interviews, meeting observations, shadowing and pricing documents.
Findings
This paper finds that pricing is a collective decision-making process involving multiple actors across the organization. The case firms work on solving information, coordination and control problems to arrive at sales prices by enacting interlinked practices. Pricing is therefore neither a structure nor a single decision but a process consisting of multiple micro-level practices that enable firms to make pricing decisions.
Originality/value
This paper develops a practice-based approach to pricing that conceptualize the micro-level practices used to to make pricing decisions in the face of information, coordination and control problems. The paper is interdisciplinary and adds to the accounting literature and the market literature, which have tended to study pricing as a decision made by one decision maker, and not as an organizational process where multiple actors share, evaluate, interpret and coordinate information and decisions.
Purpose
The purpose of this paper is to analyze price decision-making through a practice-based approach. The paper investigates the micro-level practices used to arrive at sales price decisions.
...Design/methodology/approach
In this study, a qualitative study approach is used to develop findings abductively. The data are gathered through an in-depth case study at two firms: semi-structured interviews, meeting observations, shadowing and pricing documents.
Findings
This paper finds that pricing is a collective decision-making process involving multiple actors across the organization. The case firms work on solving information, coordination and control problems to arrive at sales prices by enacting interlinked practices. Pricing is therefore neither a structure nor a single decision but a process consisting of multiple micro-level practices that enable firms to make pricing decisions.
Originality/value
This paper develops a practice-based approach to pricing that conceptualize the micro-level practices used to to make pricing decisions in the face of information, coordination and control problems. The paper is interdisciplinary and adds to the accounting literature and the market literature, which have tended to study pricing as a decision made by one decision maker, and not as an organizational process where multiple actors share, evaluate, interpret and coordinate information and decisions.
Palliative radiotherapy to patients with head and neck cancer is often necessary, but there is a substantial variation in the treatment regimens reported in the literature, and consensus on the most ...appropriate schedules does not exist. In order to minimize acute toxicity while at the same time trying to achieve prolonged tumor control, a long hypofractionated regimen has been used routinely in Denmark. In the current retrospective study, we investigated the outcome in patients intended for palliative radiotherapy with this regimen.
Patients with newly diagnosed head and neck cancer treated with palliative radiotherapy of 52-56 Gy in 13-14 fractions twice weekly from 2009 to 2014 were included. Patients were excluded if they had previously received radiotherapy. Data on disease location, stage, patient performance status (PS), treatment response, acute skin and mucosal toxicity, and late fibrosis were collected prospectively and supplemented with information from medical records.
77 patients were included in the study. Fifty-eight patients (75%) completed the intended treatment. Loco-regional tumor response (complete or partial) was evaluated 2 months posttreatment and observed in 45% of the entire population corresponding to 71% of patients alive. PS had a significant influence on survival (
= 0.007) and on not completing the intended treatment. Grade III or IV acute mucositis were observed in 25%, and grade III or IV acute dermatitis observed in 15%.
Palliative hypofractionated radiotherapy with 52-56 Gy in 13-14 fractions shows good tumor response and tolerability in a vulnerable patient population. However, it may not be suited for patients in poor PS.
In this paper, an initial rotor position detection approach for the delta-connected synchronous reluctance motor is proposed. This method estimates the rotor angular position by applying voltage ...pulses to the stator windings with appropriate switching sequences of a PWM inverter at standstill condition. It only needs the 3-phase motor line currents measurement to determine the initial position of the rotor and thus does not require any knowledge of machine parameters. This technique is based on the theory that the stator self and mutual inductances are functions of rotor positions, and the relationship between the currents and the rotor position is presented with equations. The equivalent circuits of the different conduction modes are analyzed and the experimental results have been verified, demonstrating that the technique can provide an accurate initial rotor position which can be further used in the sensorless control.
This paper is presenting a novel control strategy suitable for PMSM in industry applications such as fan and blower applications known from the heating, ventilation and air-conditioning industry or ...conveyor belt applications. Comparisons are made to the field oriented control typically used today in Industry applications for PMSM.
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