Defining Target Volumes for Stereotactic Ablative Radiotherapy of Early-stage Lung Tumours:A Comparison of Three-dimensional F-fluorodeoxyglucose Positron Emission Tomography and Four-dimensional Computed Tomography

Aims: High local control rates are achieved in stage I lung cancer using stereotactic ablative radiotherapy. Target delineation is commonly based on four-dimensional computed tomography (CT) scans. Target volumes defined by positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional') F-fluorodeoxyglucose (F-FDG) PET/CT. Materials and methods: For 16 stage I non-small cell lung cancer tumours, six approaches for deriving PET target volumes were evaluated: manual contouring, standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV (35%SUV), 41% of SUV (41%SUV) and two different source to background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum intensity projection (MIP ITV). Volumetric and positional correlation was assessed using the Dice similarity coefficient (DSC). Results: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV = 0.63, 41%SUV = 0.57. SBR-1 = 0.52, SBR-2 = 0.49. PET-based target volumes were smaller than corresponding MIP ITVs. Conclusions: Conventional three-dimensional F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use (MIP ITV). Caution is required in using three-dimensional PET for motion encompassing target volume delineation. © 2012 The Royal College of Radiologists.

Multi-Dimensional Deprivation in Ireland Among 9-Year-Olds in Ireland:An Analysis of the Growing Up in Ireland Survey’

In this paper we make use of the 9-year old wave of the Growing Up in Ireland study to analyse multidimensional deprivation in Ireland. The Alkire and Foster adjusted head count ratio approach (AHCR; 2007, 2011a, 2011b) applied here constitutes a significant improvement on union and intersection approaches and allows for the decomposition of multidimensional poverty in terms of dimensions and sub-groups. The approach involves a censoring of data such that deprivations count only for those above the specified multidimensional threshold leading to a stronger set of interrelationships between deprivation dimensions. Our analysis shows that the composition of the adjusted head ratio is influenced by a range of socio-economic factors. For less-favoured socio-economic groups dimensions relating to material deprivation are disproportionately represented while for the more advantaged groups, those relating to behavioral and emotional issues and social interaction play a greater role. Notwithstanding such variation in composition, our analysis showed that the AHCR varied systematically across categories of household type, and the social class, education and age group of the primary care giver. Furthermore, these variables combined in a cumulative manner. The most systematic variation was in relation to the head count of those above the multidimensional threshold rather than intensity, conditional on being above that cut-off point. Without seeking to arbitrate on the relative value of composite indices versus disaggregated profiles, our analysis demonstrates that there is much to be gained from adopting an approach with clearly understood axiomatic properties. Doing so allows one to evaluate the consequences of the measurement strategy employed for the understanding of levels of multidimensional deprivation, the nature of such deprivation profiles and socio-economic risk patterns. Ultimately it permits an informed assessment of the strengths and weaknesses of the particular choices made.

Childhood in transition: growing up in ‘post-conflict’ Northern Ireland

Northern Ireland is in the early stages of transition from conflict, but progress is regularly affected by political and public discontent. A divided landscape, segregated and under-resourced communities are enduring legacies of ‘the Conflict’. Yet the political will to tackle social and community division, consult with and support communities has been lacking. Grounded in six communities most affected by poverty and the Conflict this paper illustrates the difficulties, tensions and contradictions experienced during transition and how, in the process of ‘change’, children and young people have been silenced, marginalised and
demonised.

Dimensions of religious and national identity among Irish adolescents growing up in two jurisdictions

This poster explores the impact of growing up in different socio-political environments in the border areas of the Republic of Ireland (RoI) and Northern Ireland (NI) on adolescents’ evaluations of their religious and national identities. The vast majority of the population of the Republic of Ireland are Catholic and Irish whereas in Northern Ireland, the majority are Protestant and British. 713 adolescents (NI= 415; RoI=298), who categorised their religious identity as Catholic and their nationality as Irish completed the Collective Self – Esteem (CSE) scale (Crocker & Luhtanen, 1990) with reference to either their religious (N=350) or national identity (n=363). The overall rating of CSE for the Irish identity was significantly higher than the rating of CSE for the Catholic Identity. This result was modified by a significant interaction - adolescents in the Republic of Ireland rated the CSE of their Irish nationality higher than those in Northern Ireland (20.99 vs. 19.95), whereas adolescents in Northern Ireland rated the CSE of their Catholic religious identity higher than their peers in the Republic of Ireland (19.97 vs 18.87). Further analysis of the CSE subscales revealed differing patterns of relationships according to the scale. The evaluation of the Public Collective Self-Esteem of national and religious identities were significantly higher in the Republic of Ireland than in Northern Ireland, however Private Collective Self-esteem did not differ according to jurisdiction. These findings are discussed in relation to the social context and current theoretical accounts of collective identification processes.

Defining target volumes for stereotactic ablative radiotherapy of early-stage lung tumours: a comparison of three-dimensional 18F-fluorodeoxyglucose positron emission tomography and four-dimensional computed tomography.:PETCT versus 4DCT for SABR in Early Stage NSCLC

AIMS: High local control rates are achieved in stage I lung cancer using
stereotactic ablative radiotherapy. Target delineation is commonly based on
four-dimensional computed tomography (CT) scans. Target volumes defined by
positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional')
(18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT.

MATERIALS AND METHODS: For 16 stage I non-small cell lung cancer tumours, six
approaches for deriving PET target volumes were evaluated: manual contouring,
standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV
(35%SUV(MAX)), 41% of SUV(MAX) (41%SUV(MAX)) and two different source to
background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum
intensity projection (MIP(MOD) ITV). Volumetric and positional correlation was
assessed using the Dice similarity coefficient (DSC).

RESULTS: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP(MOD) ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV(MAX) = 0.63, 41%SUV(MAX) = 0.57. SBR-1 = 0.52, SBR-2 =0.49. PET-based target volumes were smaller than corresponding MIP ITVs.

CONCLUSIONS: Conventional three-dimensional (18)F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use
(MIP(MOD) ITV). Caution is required in using three-dimensional PET for motion
encompassing target volume delineation.

A multi-output two-stage locally regularized model construction method using the extreme learning machine

This paper investigates the construction of linear-in-the-parameters (LITP) models for multi-output regression problems. Most existing stepwise forward algorithms choose the regressor terms one by one, each time maximizing the model error reduction ratio. The drawback is that such procedures cannot guarantee a sparse model, especially under highly noisy learning conditions. The main objective of this paper is to improve the sparsity and generalization capability of a model for multi-output regression problems, while reducing the computational complexity. This is achieved by proposing a novel multi-output two-stage locally regularized model construction (MTLRMC) method using the extreme learning machine (ELM). In this new algorithm, the nonlinear parameters in each term, such as the width of the Gaussian function and the power of a polynomial term, are firstly determined by the ELM. An initial multi-output LITP model is then generated according to the termination criteria in the first stage. The significance of each selected regressor is checked and the insignificant ones are replaced at the second stage. The proposed method can produce an optimized compact model by using the regularized parameters. Further, to reduce the computational complexity, a proper regression context is used to allow fast implementation of the proposed method. Simulation results confirm the effectiveness of the proposed technique. © 2013 Elsevier B.V.

Seasonal and gestation stage associated differences in aflatoxin exposure in pregnant Gambian women

Objective: Aflatoxin is known to cross the placental barrier and exposures in utero could influence genomic programming, foetal growth and development, resulting in long-term health effects. We aimed to determine aflatoxin exposure in Gambian women at two stages of pregnancy and during the rainy and dry seasons.

Methods: We examined aflatoxin exposure in pregnant Gambian women at early (<16 weeks) and later (16 weeks onward) stages of pregnancy and at different times of the year, during the rainy (June to October 2009) or dry (November to May 2010) season, using aflatoxin–albumin adducts (AF-alb).

Results: Mean AF-alb was higher during the dry season than in the rainy season, in both early and later pregnancy although the difference was strongest in later pregnancy. There was a modest increase in AF-alb in later than early pregnancy (geometric mean 41.8 vs. 34.5 pg/mg, P < 0.05), but this was restricted to the dry season when exposures were generally higher.

Conclusions: The study confirmed that Gambian pregnant women were exposed to aflatoxin throughout the pregnancy, with higher levels in the dry season. There was some evidence in the dry season that women in later pregnancy had higher AF-alb levels than those in earlier pregnancy. Further research on the effects of exposure to this potent mutagen and carcinogen throughout pregnancy, including the epigenetic modification of foetal gene expression and impact on pre- and post-natal growth and development, are merited.

Novel genetic susceptibility loci for diabetic end-stage renal disease identified through robust naive Bayes classification

Aims/hypothesis: Diabetic nephropathy is a major diabetic complication, and diabetes is the leading cause of end-stage renal disease (ESRD). Family studies suggest a hereditary component for diabetic nephropathy. However, only a few genes have been associated with diabetic nephropathy or ESRD in diabetic patients. Our aim was to detect novel genetic variants associated with diabetic nephropathy and ESRD. Methods: We exploited a novel algorithm, ‘Bag of Naive Bayes’, whose marker selection strategy is complementary to that of conventional genome-wide association models based on univariate association tests. The analysis was performed on a genome-wide association study of 3,464 patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and subsequently replicated with 4,263 type 1 diabetes patients from the Steno Diabetes Centre, the All Ireland-Warren 3-Genetics of Kidneys in Diabetes UK collection (UK–Republic of Ireland) and the Genetics of Kidneys in Diabetes US Study (GoKinD US). Results: Five genetic loci (WNT4/ZBTB40-rs12137135, RGMA/MCTP2-rs17709344, MAPRE1P2-rs1670754, SEMA6D/SLC24A5-rs12917114 and SIK1-rs2838302) were associated with ESRD in the FinnDiane study. An association between ESRD and rs17709344, tagging the previously identified rs12437854 and located between the RGMA and MCTP2 genes, was replicated in independent case–control cohorts. rs12917114 near SEMA6D was associated with ESRD in the replication cohorts under the genotypic model (p < 0.05), and rs12137135 upstream of WNT4 was associated with ESRD in Steno. Conclusions/interpretation: This study supports the previously identified findings on the RGMA/MCTP2 region and suggests novel susceptibility loci for ESRD. This highlights the importance of applying complementary statistical methods to detect novel genetic variants in diabetic nephropathy and, in general, in complex diseases.

Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

New technology and new workplaces: call centre careers – a growing reality?

Research to date suggests that career advancement in call centres (CCs) is relatively uncommon with employees often viewing such employment as a stopgap measure before moving on to something better. This study set out to determine whether such scenarios have changed over time since CCs have become more established in their work organisation, information and communication technology (ICT) and management processes. This study particularly focused on training and development initiatives, how employees access training and development, and whether CCs support career development. Using both qualitative and quantitative methods, these issues are examined within 10 Australian CCs of varying size from various sectors. Two-thirds of respondents stated that they intended to develop a career in the industry and 7 in 10 reported that they believed there were promotional opportunities emerging in their current organisation. Despite these findings, the evidence also suggests that more needs to be done both to create coherent career paths and to establish structured, accredited training programmes for CC employees.

Thinking about the past, present and future in adolescents growing up in Children's Homes

The present study tested the hypothesis that adolescents growing up in Children's Homes differ from adolescents growing up in a family environment in how they think about their past, present and future, in the way they make decisions about future events and rewards, and in their levels of empathy and perspective taking. The participants were 40 adolescents from Children's Homes in Budapest, Hungary, and 40 age- and gender-matched controls. Group differences were found in participants' past and present time perspectives, and girls from Children's Homes showed reduced consistency in their plans for the future. Additionally, gender differences emerged in empathy, perspective taking, and in participants' present and future time perspectives. We discuss the implications of our findings for interventions to improve the future prospects of adolescents in Children's Homes.