Radiation therapy to the pelvic lymph nodes in high-risk prostate cancer is required on several Radiation Therapy Oncology Group (RTOG) clinical trials. Based on a prior lymph node contouring ...project, we have shown significant disagreement in the definition of pelvic lymph node volumes among genitourinary radiation oncology specialists involved in developing and executing current RTOG trials.
A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data were presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop clinical target volume (CTV) pelvic lymph node consensus.
Consensus was obtained resulting in computed tomography image-based pelvic lymph node CTVs. Based on this consensus, the pelvic lymph node volumes to be irradiated include: distal common iliac, presacral lymph nodes (S(1)-S(3)), external iliac lymph nodes, internal iliac lymph nodes, and obturator lymph nodes. Lymph node CTVs include the vessels (artery and vein) and a 7-mm radial margin being careful to "carve out" bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on dose-volume histogram constraints for OARs was also attained.
Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based computed tomography images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment.
•Political polarization in climate change views increases with higher education and income.•Higher education particularly strengthens the conservative white male (CWM) effect.•Individualism mediates ...the ideological divide in climate change views.•Individualism mediates the CWM effect only for those with higher education.
Previous research documents that U.S. conservatives, and conservative white males in particular, tend to dismiss the threat of climate change more than others in the U.S. public. Other research indicates that higher education and income can each exacerbate the dismissive tendencies of the political Right. Bridging these lines of research, the present study examines the extent to which higher education and/or income moderate the ideological divide and the “conservative white male effect” on several climate change opinions, and whether these effects are mediated by an individualistic worldview (e.g., valuing individual liberty and limited government). Using nationally representative survey data of U.S. adults from 2008 to 2017 (N = 20,024), we find that across all beliefs, risk perceptions, and policy preferences examined, the ideological divide strengthens with both higher education and higher income. However, educational attainment plays a stronger role than income in polarizing the views of conservative white males. Further analyses support the hypothesis that differences in individualism partially explain the increased political polarization among more educated and higher-income adults, as well as greater dismissiveness among conservative white males relative to other demographic groups. These results highlight key moderators of opinion polarization, as well as ideological differences among conservatives, that are often overlooked in public discourse about climate change. Implications for climate change education and communication across demographic groups are considered.
Background
The combination of chemotherapy with thoracic radiotherapy (TRT) compared with TRT alone has been shown to confer a survival advantage for good performance status patients with stage III ...non-small cell lung cancer. However, it is not known whether sequential or concurrent delivery of these therapies is the optimal combination strategy.
Methods
A total of 610 patients were randomly assigned to two concurrent regimens and one sequential chemotherapy and TRT regimen in a three-arm phase III trial. The sequential arm included cisplatin at 100 mg/m2 on days 1 and 29 and vinblastine at 5 mg/m2 per week for 5 weeks with 60 Gy TRT beginning on day 50. Arm 2 used the same chemotherapy regimen as arm 1 with 60 Gy TRT once daily beginning on day 1. Arm 3 used cisplatin at 50 mg/m2 on days 1, 8, 29, and 36 with oral etoposide at 50 mg twice daily for 10 weeks on days 1, 2, 5, and 6 with 69.6 Gy delivered as 1.2 Gy twice-daily fractions beginning on day 1. The primary endpoint was overall survival, and secondary endpoints included tumor response and time to tumor progression. Kaplan-Meier analyses were used to assess survival, and toxic effects were examined using the Wilcoxon rank sum test. All statistical tests were two-sided.
Results
Median survival times were 14.6, 17.0, and 15.6 months for arms 1-3, respectively. Five-year survival was statistically significantly higher for patients treated with the concurrent regimen with once-daily TRT compared with the sequential treatment (5-year survival: sequential, arm 1, 10% 20 patients, 95% confidence interval CI = 7% to 15%; concurrent, arm 2, 16% 31 patients, 95% CI = 11% to 22%, P = .046; concurrent, arm 3, 13% 22 patients, 95% CI = 9% to 18%). With a median follow-up time of 11 years, the rates of acute grade 3-5 nonhematologic toxic effects were higher with concurrent than sequential therapy, but late toxic effects were similar.
Conclusion
Concurrent delivery of cisplatin-based chemotherapy with TRT confers a long-term survival benefit compared with the sequential delivery of these therapies.
To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials.
One male pelvis computed tomography (CT) data set and one female pelvis CT data ...set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified.
The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa_R, Adnexa_L, Prostate, SeminalVesc, PenileBulb, Femur_R, and Femur_L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed.
Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.
Narcissistic leadership Rosenthal, Seth A.; Pittinsky, Todd L.
The Leadership quarterly,
12/2006, Letnik:
17, Številka:
6
Journal Article
Recenzirano
Narcissism—a personality trait encompassing grandiosity, arrogance, self-absorption, entitlement, fragile self-esteem, and hostility—is an attribute of many powerful leaders. Narcissistic leaders ...have grandiose belief systems and leadership styles, and are generally motivated by their needs for power and admiration rather than empathetic concern for the constituents and institutions they lead. However, narcissists also possess the charisma and grand vision that are vital to effective leadership. We review and critically assess the theoretical and research literature on narcissistic leaders in order to understand the potential positive and negative consequences of their leadership, the trajectories of their leadership, and the relationship of narcissism to established models of leadership. We conclude that the study of narcissistic leaders is inherently limited in scope, and propose a new definition of narcissistic leader
ship in order to reframe the discussion and better incorporate the topic of narcissism into the field of leadership studies.
Long-term research in ecology and evolution Kuebbing, Sara E.; Reimer, Adam P.; Rosenthal, Seth A. ...
Ecological monographs,
20/May , Letnik:
88, Številka:
2
Journal Article
Recenzirano
Long-term research in ecology and evolution (LTREE) is considered fundamental for understanding complex ecological and evolutionary dynamics. However, others have argued for revision of LTREE efforts ...given perceived limitations in current research priorities and approaches. Yet most arguments about the benefits and failings of LTREE could be argued to reflect the views of only the limited number of scientists who have authored reports on the field, and not the wider community of ecological and evolutionary scientists. To more systematically and quantitatively assess the views of the community on LTREE contributions and future activities, we conducted and here report the results of a survey of ecological and evolutionary scientists at primarily U.S.-based institutions, completed by 1,179 respondents. The survey objectives were to (1) identify and prioritize research questions that are important to address through long-term, ecological field experiments and (2) understand the role that these experiments might play in generating and applying ecological and evolutionary knowledge. Almost 80% (𝑛 = 936) of respondents said that long-term experiments had contributed "a great deal" to ecological understanding. Compared to other research approaches (e.g., short-term, single-site, modeling, or lab), there was overwhelming support that multi-site, long-term research was very important for advancing theory, and that both observational and experimental approaches were required. Respondents identified a wide range of research questions for LTREE to address. The most common topic was the impact of global change (𝑛 = 1,352), likely because these processes play out over many years, requiring LTREE approaches to fully understand. Another recurrent theme was the potential of LTREE approaches to build evolutionary understanding across all levels of ecological organization. Critical obstacles preventing some scientists from engaging in LTREE included short-term funding mechanisms and fewer publications, whereas the longer-term value for advancing knowledge and an individual's career were widely recognized. Substantive advances in understanding ecological and evolutionary dynamics then seem likely to be made through engagement in long-term observational and experimental research. However, wider engagement seems dependent on a more supportive research environment and funding structure, through increased institutional acknowledgment of the contributions of long-term research, and greater program support during the establishment and maintenance of research.
Beliefs and attitudes form the core of public opinion about climate change. Network analysis can reveal the structural configuration of these beliefs and attitudes. In this research, we utilize a ...belief system framework to identify key psychological elements, track change in the density of these belief systems over time and across political groups, and analyze the structural heterogeneity of belief systems within and between political groups in the United States. Drawing on fifteen waves of nationally representative survey data from 2010 to 2021 (N = 16,742), our findings indicate that worry about climate change is the most central psychological element. Interestingly, we find that among politically unaffiliated individuals, the connections between psychological elements have strengthened over time, implying an increase in the consistency of belief systems within this group. Despite the political polarization in beliefs about climate change between Republicans and Democrats, our findings reveal that the ways these two groups organize and structure climate change beliefs systems are not markedly different compared to those of other groups. These findings provide theoretical and practical insights for climate change experts and communicators.
Artificial intelligence (AI) is emerging as a technology with the power to transform established industries, and with applications from automated manufacturing to advertising and facial recognition ...to fully autonomous transportation. Advances in each of these domains have led some to call AI the “fourth” industrial revolution 1. In healthcare, AI is emerging as both a productive and disruptive force across many disciplines. This is perhaps most evident in Diagnostic Radiology and Pathology, specialties largely built around the processing and complex interpretation of medical images, where the role of AI is increasingly seen as both a boon and a threat. In Radiation Oncology as well, AI seems poised to reshape the specialty in significant ways, though the impact of AI has been relatively limited at present, and may rightly seem more distant to many, given the predominantly interpersonal and complex interventional nature of the specialty. In this overview, we will explore the current state and anticipated future impact of AI on Radiation Oncology, in detail, focusing on key topics from multiple stakeholder perspectives, as well as the role our specialty may play in helping to shape the future of AI within the larger spectrum of medicine.
Despite Greta Thunberg's popularity, research has yet to investigate her impact on the public's willingness to take collective action on climate change. Using cross‐sectional data from a nationally ...representative survey of U.S. adults (N = 1,303), we investigate the “Greta Thunberg Effect,” or whether exposure to Greta Thunberg predicts collective efficacy and intentions to engage in collective action. We find that those who are more familiar with Greta Thunberg have higher intentions of taking collective actions to reduce global warming and that stronger collective efficacy beliefs mediate this relationship. This association between familiarity with Greta Thunberg, collective efficacy beliefs, and collective action intentions is present even after accounting for respondents’ overall support for climate activism. Moderated mediation models testing age and political ideology as moderators of the “Greta Thunberg Effect” indicate that although the indirect effect of familiarity with Greta Thunberg via collective efficacy is present across all age‐groups, and across the political spectrum, it may be stronger among those who identify as more liberal (than conservative). Our findings suggest that young public figures like Greta Thunberg may motivate collective action across the U.S. public, but their effect may be stronger among those with a shared political ideology. Implications for future research and for broadening climate activists’ appeals across the political spectrum are discussed.
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