Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer

Background: As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Methods: Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24,and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. Results: The largest differences in QOL occurred in the first 1-6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Conclusions: Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.

Characterization and drying of caja bagasse (Spondias mombin L.) in a tray dryer using a factorial planning

The caja (Spondias mombin L.) is used in the manufacture of ice-cream, jams, pulps, beverages being also consumed in natura. One of the most important procedures in food conservation is drying, considering that most fresh fruits contain approximately 80% of water. Food drying is used to obtain two basic aspects: (1) the economic factor; in the shipping and handling of the product; (2) at the manipulation; once dried and grinded, the material is rehydrated, at desirable levels, to formulate a new product as in ice cream, jams, yoghurts and drinks and may also be added to pasta, biscuits and other industrialized products. The aim of this study was to investigate the kinetics of caja bagasse drying in a fixed-bed tray dryer, using central composite factorial planning. The following factors were evaluated: temperature (55, 65 and 75 ºC), dryer inlet air velocity (3.2, 4.6 and 6.0 m.s-1) and cake thickness (0.8, 1.2 and 1.6 cm) where the response of the considered variable was caja bagasse moisture content (b.s.) and the results showed that the main effects and their interactions were significant at a 95% confidence level being the best condition obtained at temperature of 75 ºC, velocity of 6.0 m.s-1 and cake thickness of 0.8 cm.

Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis.

BACKGROUND: A previous individual patient data meta-analysis by the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) collaborative group to assess the addition of chemotherapy to radiotherapy showed that it improves overall survival in nasopharyngeal carcinoma. This benefit was restricted to patients receiving concomitant chemotherapy and radiotherapy. The aim of this study was to update the meta-analysis, include recent trials, and to analyse separately the benefit of concomitant plus adjuvant chemotherapy. METHODS: We searched PubMed, Web of Science, Cochrane Controlled Trials meta-register, ClinicalTrials.gov, and meeting proceedings to identify published or unpublished randomised trials assessing radiotherapy with or without chemotherapy in patients with non-metastatic nasopharyngeal carcinoma and obtained updated data for previously analysed studies. The primary endpoint of interest was overall survival. All trial results were combined and analysed using a fixed-effects model. The statistical analysis plan was pre-specified in a protocol. All data were analysed on an intention-to-treat basis. FINDINGS: We analysed data from 19 trials and 4806 patients. Median follow-up was 7·7 years (IQR 6·2-11·9). We found that the addition of chemotherapy to radiotherapy significantly improved overall survival (hazard ratio [HR] 0·79, 95% CI 0·73-0·86, p<0·0001; absolute benefit at 5 years 6·3%, 95% CI 3·5-9·1). The interaction between treatment effect (benefit of chemotherapy) on overall survival and the timing of chemotherapy was significant (p=0·01) in favour of concomitant plus adjuvant chemotherapy (HR 0·65, 0·56-0·76) and concomitant without adjuvant chemotherapy (0·80, 0·70-0·93) but not adjuvant chemotherapy alone (0·87, 0·68-1·12) or induction chemotherapy alone (0·96, 0·80-1·16). The benefit of the addition of chemotherapy was consistent for all endpoints analysed (all p<0·0001): progression-free survival (HR 0·75, 95% CI 0·69-0·81), locoregional control (0·73, 0·64-0·83), distant control (0·67, 0·59-0·75), and cancer mortality (0·76, 0·69-0·84). INTERPRETATION: Our results confirm that the addition of concomitant chemotherapy to radiotherapy significantly improves survival in patients with locoregionally advanced nasopharyngeal carcinoma. To our knowledge, this is the first analysis that examines the effect of concomitant chemotherapy with and without adjuvant chemotherapy as distinct groups. Further studies on the specific benefits of adjuvant chemotherapy after concomitant chemoradiotherapy are needed. FUNDING: French Ministry of Health (Programme d'actions intégrées de recherche VADS), Ligue Nationale Contre le Cancer, and Sanofi-Aventis.

Adjuvant radiotherapy for gastric carcinoma: 10 years follow-up of 244 cases from a single institution.

BACKGROUND: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high- risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. MATERIALS AND METHODS: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. RESULTS: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. CONCLUSIONS: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.

Offering Analysis in New Product Launch and Sales Planning

This Master's Thesis has been written for Stora Enso Flexible Packaging Papers business unit. In the North-American mills, the business unit has developed a range of new flexible packaging paper grades. The Master's Thesis researches opportunities for sales of these new flexible packaging papers in selected Western-European markets. This study consists of theoretical and empirical part. Theoretical part presents supply chain of flexible packaging, discovering of customer requirements, concept of an offering, general market analysis, customer analysis and basis for sales planning. Empirical part includes preliminary market analysis based on secondary sources, results of lead user interviews and conclusions and recommendations. Potential customers' technical and commercial requirements were found and these were compared to current Stora Enso Flexible Packaging Papers offering. Also a list of potential new customers was made and sales action suggestions were presented in order to gain new accounts.

Success Factors of an Enterprise Resource Planning System

Työn tarkoituksena oli tutkia yrityksen eri yksiköiden toiminnaohjausjärjestelmiä sekä verrata niiden menestystekijöitä Adelakunin malliin tietojärjestelmien laatuulottuvuuksista. Siinä järjestelmän kokonaislaatu jaetaan liiketoiminnalliseen, tekniseen ja käyttäjän kokemaan laatuun. Tulosten perusteella oli myös tavoitteena kehittää kyseisen toiminnanojausjärjestelmän kehittämistä varten malli onnistumistekijöiden keskinäisestä riippuvuudesta. Tutkittavista järjestelmistä ja niiden käytöstä kerättiin tietoja käyttöönottoprojektien dokumentaatiosta, haastatteluin, kyselylomakkein ja järjestelmäanalyysein. Sekä loppukäyttäjät että yritysjohto olivat kyselyjen ja haastattelujen kohderyhmänä. Saatuja tietoja arvioitiin Adelakunin kolmiulotteisen tietojärjestelmän laatutekijämallin mukaisesti ja keskeisiä menestystekijöitä etsittiin. Tutkituissa tapauksissa tietojärjestelmien menestyksen taustalta löytyi alan kirjallisuuden kanssa yhtäpitäviä tekijöitä. Myös Adelakunin laatu-ulottuvuusmalli osoittautui validiksi tutkituissa tapauksissa. Keskeisten menestystekijöiden välisistä vuorovaikutussuhteista rakennettiin malli, jota voidaan hyödyntää kyseisen järjestelmän jatkokehityksessä.

Tales of the City. Storytelling as a contemporary tool of urban planning and design

Almost thirty years ago, as the social sciences underwent their 'discursive turn', Bernardo Secchi (1984) drew, in what he called the 'urban planning narrative', the attention of planners to the production of myths, turning an activity often seen as primarily technical into one centred around the production of images and ideas. This conception of planning practice gave rise to a powerful current of research in English-speaking countries. Efforts were made to both combine the urban planning narrative with storytelling and to establish storytelling as a prescriptive or descriptive model for planning practice. Thus, just as storytelling is supposed to have led democratic communication off track through a pronounced concern for a good story, storytelling applied to the field of urban production may have led to an increasing preoccupation with staging and showmanship for projects to the detriment of their real inclusion in political debate. It is this possible transformation of the territorial action that will be the focus of the articles collected in this special issue of Articulo - Journal of urban research.

Net communication strategy planning and management

Tutkielman tavoitteena on selvittää kuinka suunnitella ja hallita tehokasta verkkoviestintää, joka vastaa kohdeyleisön ja palvelun ylläpitäjien kasvaviin vaatimuksiin. Tutkielma on normatiivinen tapaustutkimus, jonka tuloksena syntyy konstruktiivinen askelmalli kokonaisvaltaisen verkkoviestintäprojektin toteuttamiseen. Tutkimus esittää myös teoreettisesti merkittävän näkökulman verkkopalvelujen sisällön hallintaongelmien ratkaisemiseen. Tosielämän verkkoviestintäprojektin toteutusta seurataan TietoEnator Forestissa, jossa tutkielman kirjoittaja työskentelee. Tutkimusmateriaalina käytetään 11 TietoEnator Forestissa toteutettua haastattelua, TietoEnator konsernin dokumentaatiota ja osallistuvaa havainnointia. Haastattelulomake sisältää 13 avointa kysymystä, jotka käsittelevät verkkoviestintästrategian perusasioita. Tunnistetut verkkoviestinnän avainmenestystekijät ovat vahva sisäinen sitoutuminen hajautettuihin ylläpitorooleihin ja perinpohjainen asiakastarpeiden tunnistaminen. Teknisesti on tärkeää, että eritason verkkoympäristöt, Internet, Intranet ja Extranet, hallitaan samoilla sisällönhallinta työkaluilla. Näin pystytään rationalisoimaan ylläpitotoiminnot.

Planning and Implementing a New Corporate Identity in a Global Service Company, Case: TNT International Express

Tutkielman tavoitteena on tarkastella uuden yritysidentiteetin suunnittelua ja käyttöönottoa maailmanlaajuisessa palveluyrityksessä. Tutkielma jakaantuu teoreettiseen ja empiiriseen osaan. Teoreettisessa osassa käsitellään yritysidentiteetin käsitettä sekä tarkastellaan uuden yritysidenteetin suunnittelua ja käyttöönottoa. Teoriaa tarkastellaan keskeisten kirjallisten lähteiden perusteella, jotka käsittelevät markkinoinnin johtamista, palveluyritystä, yritysidentiteettiä, imagoa ja brändiä. Empiirinen tarkastelu pohjautuu yritysesimerkkiin. Yritysesimerkkinä on maailmanlaajuinen palveluyritys, ja sen uuden yritysidentiteetin suunnittelu- ja lanseeraustoimenpiteet. Empiirinen aineisto perustuu markkinointipäälliköiden haastatteluihin Australiassa ja Suomessa sekä yrityksen sisäiseen suunnittelu- ja lanseerausmateriaaliin. Tutkielmassa tulee esille yritysidentiteettikäsitteen monimuotoisuus. Yritysidentiteetin rakentaminen lähtee visiosta, missiosta ja yrityksen tavoitteista, jotka pitää olla selkeät ja johdonmukaiset. Yritysidentiteetti käsittää visuaalisen ilmeen lisäksi kaikki ne prosessit, joissa ollaan tekemisissä sidosryhmien kanssa. Yritysidentiteetin rakentaminen ja ylläpitäminen vaatii, että jokainen liiketoimintafunktio ymmärtää yritysidenteetin sisällön ja toimii sen mukaisesti kaikissa tilanteissa. Yrityksen on viestittävä henkilöstölle ja ulkoisille sidosryhmilleen, miksi se on olemassa. Henkilöstön tulee ymmärtää yrityksen tapa toimia, jotta he pystyvät vastaamaan yrityksen asettamiin haasteisiin kohdatessaan asiakkaan. Uuden yritysidentiteetin suunnitteluun on panostettava. Onnistumisen edellytykseksi osoittautui, että suunnitellaan tarkasti toimenpiteet ennen käyttöönottoa, käyttöönoton aikana sekä käyttöönoton jälkeen.

Profit repatriation of a Polish subsidiary from tax planning point of view of an international corporation

The main purpose of this study was to examine and compare the possibilities of profit repatriation from the point of view of tax planning of an international corporation, in such a case that a Finnish parent company has a subsidiary in Poland. The main research problem was divided into two sub research problems: 1) to examine concepts and principles of international taxation and tax planning from the point of view of international corporations and 2) to discuss the main features of Polish Companies-, Accounting- and Tax Act from the point of view a Finnish parent company. The research method of this study is mainly decision making, comparative analysis. In this study have been discussed the possibilities of international profit repatriation for supporting the decision making of the management of a Finnish parent company. In addition different repatriation possibilities have been compared. In this study has been noticed that a Finnish parent company can repatriate profit of its Polish subsidiary either directly as dividends or by using indirect methods such as interests, royalties, management fees and transfer pricing of goods. The total tax burden of dividends is heavier than the tax burden of indirect methods. It was also concluded that during the last years the Polish legislation has been renewed in order to prevent hidden dividend distribution. This has been done by implementing new rules of transfer pricing and thin capitalization.