Systematic dosimetric evaluation of risk of osteoradionecrosis (DERO): First results of dose reporting for preventing teeth osteoradionecrosis after head and neck irradiation.

PURPOSE: OsteoRadioNecrosis (ORN) is a late complication of radiation for head and neck cancer. Predicting ORN is a major challenge. We developed DERO (Dosimetric Evaluation of Risk of ORN), a semi-automatic tool which reports doses delivered to tooth-bearing sectors, to guide post-therapeutic dental care. We present the method and the first results of a 125-patient prospective cohort. MATERIAL AND METHODS: Dosimetric data of patients treated with IMRT for head and neck cancer were prospectively segmented to the DERO algorithm. Four arches corresponding to 8-tooth sectors were semi-automatically generated. Thirty-two cylindrical Regions Of Interest (ROI) corresponding to each tooth and surrounding periodontium were created by linear interpolation. Mean doses (Dmean) of ROI were extracted and included in a database, along with data about primary tumor site, laterality and dose values from organs at risk. Dmean to tooth sectors were computed for molar sectors, (teeth X5 to X8) and anterior sectors (teeth X1 to X4). An individual dose map was generated and delivered to patients and dentists. RESULTS: Dosimetric data from 125 patients treated with Tomotherapy® were prospectively collected and analyzed: 9 parotid tumors (PA), 41 Sub-Hyoid tumors (larynx, hypopharynx) (SH), 43 Oropharynx tumors (OR), 32 Oral Cavity tumors (OC). Irradiation was unilateral for 100% of PA tumors (9), 12% of OR tumors (5) and 47% of OC tumors (15). For unilateral cervical irradiation, Dmean in ipsilateral molar sectors was 54Gy for OC tumors, 45Gy for OR tumors, 20Gy for PA tumors. For Oral Cavity bilateral irradiation, Dmean was high in all tooth sectors, 49 to 55Gy. For SH tumors, Dmean in molar sectors was 27Gy. A dose gradient of 10 to 20Gy was observed between molar and anterior sectors whether radiation was uni or bilateral. CONCLUSION: Mandibular molar sectors of Oropharynx and Oral Cavity tumors were exposed to high Dmean of 40 to 50Gy. On the other hand, tooth sectors received lower doses for SH radiation. The DERO tool guide post-radiation dental care with a personalized dosimetric cartography to patient. With data update and patient follow-up, we will be able to determine ORN risk after head and neck radiation.

Cost-effectiveness of hypofractionated versus conventional radiotherapy in patients with intermediate-risk prostate cancer: An ancillary study of the PROstate fractionated irradiation trial - PROFIT.

PURPOSE: To evaluate the cost-effectiveness of moderate Hypofractionated Radiotherapy (H-RT) compared to Conventional Radiotherapy (C-RT) for intermediate-risk prostate caner (PCa). METHODS: A prospective randomized clinical trial including 222 patients from six French cancer centers was conducted as an ancillary study of the international PROstate Fractionated Irradiation Trial (PROFIT). We carried-out a cost-effectiveness analysis (CEA) from the payer's perspective, with a time horizon of 48 months. Patients assigned to the H-RT arm received 6000 cGy in 20 fractions over 4 weeks, or 7800 cGy in 39 fractions over 7 to 8 weeks in the C-RT arm. Patients completed quality of life (QoL) questionnaire: Expanded Prostate Cancer Index Composite (EPIC) at baseline, 24 and 48 months, which were mapped to obtain a EuroQol five-dimensional questionnaire (EQ-5D) equivalent to generate Quality Adjusted Life Years (QALY). We assessed differences in QALYs and costs between the two arms with Generalized Linear Models (GLMs). Costs, estimated in euro (€) 2020, were combined with QALYs to estimate the Incremental Cost-effectiveness ratio (ICER) with non-parametric bootstrap. RESULTS: Total costs per patien were lower in the H-RT arm compared to the C-RT arm €3,062 (95 % CI: 2,368 to 3,754) versus €4,285 (95 % CI: 3,355 to 5,215), (p < 0.05). QALY were marginally higher in the H-RT arm, however this difference was not significant: 0.044 (95 % CI: - 0.016 to 0.099). CONCLUSIONS: Treating localized prostate cancer with moderate H-RT could reduce national health insurance spending. Adopting such a treatment with an updated reimbursement tariff would result in improving resource allocation in RT management.

How has urban water metabolism been communicated? Perspectives from the USA, Europe and Australia.

Urban metabolism is increasingly being adopted to guide city planning towards improved water, energy and material efficiency. Stakeholder participation in the adoption of this concept will be important, and hence effective communication will be crucial. This study aimed to determine how urban metabolism has been communicated and interpreted, with attention to water. The approach included (i) literature review, (ii) structured international interviews and (iii) thematic analysis. We demonstrate how diverse language, metaphors, methods, visual imagery, data and information have been used to communicate this complex topic. Maps, Sankey diagrams, concept figures, spider diagrams, pictorial flow diagrams, art, and animation have all been used. We observe barriers to communication in order to understand the communication techniques which may be effective, and clarify issues relating to awareness and target audiences. We include a discussion of the themes that emerged from the research that are relevant for integrated water planning and the power of visual imagery. Inconsistent language is influenced by widely different overarching metaphors which range from 'organism' to 'ecosystem' metabolism. Fragmented data are a major gap for shared understanding. The research provides new understanding of how stakeholders perceive urban water metabolism and its relationship to Integrated urban water management.

The positive benefit of Lactobacillus paracasei NCC2461 ST11 in healthy volunteers with moderate to severe dandruff.

Dandruff is a common persistent, relapsing inflammatory condition affecting the scalp. An imbalanced proportion of the major bacterial and fungal populations colonising the scalp, a skin barrier dysfunction, and hyperseborrhoea are three main etiological factors of dandruff. The efficacy of Lactobacillus paracasei NCC 2461 ST11 (ST11) to manage dandruff and to restore a balanced scalp microbiome was assessed. Sixty healthy male volunteers aged 18 to 60 years with moderate to severe dandruff consumed on a daily basis a sachet containing ST11 (1×109 cfu) or a placebo for 56 days. Clinical efficacy (free and adherent dandruff, erythema, scalp seborrhoea, global clinical score), subject self-assessments, safety reporting as well as scalp microbiota assessments were performed every two weeks (day 1, 15, 29, 43, 57 and 64/follow-up). Free and adherent dandruff, erythema and the global clinical score improved significantly (all P<0.05) over time in the ST11 group and as compared to the placebo when day 57 was compared to day 1. Self-assessments paralleled these findings. ST11 enhanced restoring the scalp microbiota after 56 days of supplementation when compared to the placebo. No adverse events were reported. Regular intake of ST11 over 56 days is safe and reduces significantly the severity of signs and symptoms of moderate to severe dandruff. Its efficacy is potentially due to its positive impact on the skin barrier and skin immune system.

Urban water metabolism indicators derived from a water mass balance - Bridging the gap between visions and performance assessment of urban water resource management.

Improving resource management in urban areas has been enshrined in visions for achieving sustainable urban areas, but to date it has been difficult to quantify performance indicators to help identify more sustainable outcomes, especially for water resources. In this work, we advance quantitative indicators for what we refer to as the 'metabolic' features of urban water management: those related to resource efficiency (for water and also water-related energy and nutrients), supply internalisation, urban hydrological performance, sustainable extraction, and recognition of the diverse functions of water. We derived indicators in consultation with stakeholders to bridge this gap between visions and performance indicators. This was done by first reviewing and categorising water-related resource management objectives for city-regions, and then deriving indicators that can gauge performance against them. The ability for these indicators to be quantified using data from an urban water mass balance was also examined. Indicators of water efficiency, supply internalisation, and hydrological performance (relative to a reference case) can be generated using existing urban water mass balance methods. In the future, indicators for water-related energy and nutrient efficiencies could be generated by overlaying the urban water balance with energy and nutrient data. Indicators of sustainable extraction and recognising diverse functions of water will require methods for defining sustainable extraction rates and a water functionality index.

The genetic prehistory of the New World Arctic.

The New World Arctic, the last region of the Americas to be populated by humans, has a relatively well-researched archaeology, but an understanding of its genetic history is lacking. We present genome-wide sequence data from ancient and present-day humans from Greenland, Arctic Canada, Alaska, Aleutian Islands, and Siberia. We show that Paleo-Eskimos (~3000 BCE to 1300 CE) represent a migration pulse into the Americas independent of both Native American and Inuit expansions. Furthermore, the genetic continuity characterizing the Paleo-Eskimo period was interrupted by the arrival of a new population, representing the ancestors of present-day Inuit, with evidence of past gene flow between these lineages. Despite periodic abandonment of major Arctic regions, a single Paleo-Eskimo metapopulation likely survived in near-isolation for more than 4000 years, only to vanish around 700 years ago.

Absorption and isomerization of caffeoylquinic acids from different foods using ileostomist volunteers.

BACKGROUND: Polyphenols are thought to play important roles in human nutrition and health but these health effects are dependent on their bioavailability. This study is one of a series with the aim of determining possible effects of food matrices on caffeoylquinic acid (CQA) bioavailability using ileostomy volunteers. METHODS: After a CQA-free diet, ileostomists consumed coffee (746 µmol total CQA), and CQAs in excreted ileal fluid were subsequently identified and quantified with HPLC-diode array detection and HPLC-ESI-MS/MS. In our previous studies, other food sources such as cloudy apple juice (CAJ) (358 µmol CQA) and apple smoothie (AS) (335 µmol CQA) were investigated with the same model. RESULTS: Interesterification of CQA from both apple matrices was observed during gastrointestinal passage, whereas CQA consumed in coffee was not influenced by interesterification reactions. In total, 74.3, 22.4, and 23.8 % of the CQA from CAJ, AS, and coffee, respectively, were absorbed or degraded. CONCLUSION: Our results show that variations in food matrices and variations in phenolic composition have a major influence on intestinal bioavailability and interesterification of the investigated subclass of polyphenols, the CQAs.

Changing subsistence practices at the Dorset Paleoeskimo site of Phillip's Garden, Newfoundland.

A comparison of identified faunal assemblages from the Dorset site of Phillip's Garden indicates that harp seal hunting was the main focus of activity throughout the site's occupation. Despite the highly specialized nature of site use, it appears that reliance on harp seal decreased over time while fish and birds became increasingly important. These changes may reflect longer seasonal occupations at the site in later centuries, and/or a decrease in the local availability of harp seal. The observed shift coincides with the onset of a local climatic warming trend, which might have affected harp seal movements in the area. Dorset subsistence and settlement patterns in Newfoundland are still poorly understood due to a lack of preserved faunal assemblages in the region. The temporal trend illustrated here indicates that we cannot assume that these patterns were static throughout the Dorset occupation of the island.