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BACKGROUND This study assesses whether 90-day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality. METHODS All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Patients were divided into rurality areas according to the Modified Statistics Canada (mSC) definition, which classifies a population

Background A retrospective, population-based analysis of 90-day mortality in patients with squamous cell carcinoma of the head and neck treated with radiotherapy was performed to determine the early mortality rate and associated risk factors. Methods Data were abstracted for all consecutive patients with cancer of the head and neck treated from 1998 to 2014 at the BC Cancer Agency with curative intent radiotherapy (n = 5658). Logistic regression analysis was used to determine factors associated with early mortality. Results The median age at diagnosis was 63 years. The mortality rate at 90 days after starting radiotherapy (RT) was 3.6% (n = 203/5658). The cause of death was attributed to head and neck cancer for 81% of patients. Multivariate analysis demonstrated that increasing age, oral cavity subsite, and advanced T and N classification were associated with an increased risk of early mortality (p Conclusions The risk of early mortality was 3.6%. Elderly patients with advanced T and N classification had the highest risk of early mortality.

Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

Objectives/Hypothesis To assess for potential urban and rural disparities in head and neck cancer (HNC) outcomes within a single-payer healthcare system. Study Design A large retrospective population-based cohort analysis of consecutive HNC patients treated in British Columbia, Canada between 2001 and 2010 was conducted. Methods All patients diagnosed with HNC from 2001 to 2010 and referred to any one of five British Columbia Cancer Agency centers for management were reviewed. Based on census data, patients were classified into: 1) rural, 2) small urban, 3) moderate urban, and 4) large urban areas. Kaplan-Meier methods and Cox regression models were used to correlate site of residence with overall survival (OS), controlling for prognostic factors that included sociodemographic and other tumor and treatment-related characteristics. Results We identified 3,036 patients; the median age was 64 years, 26% were women, and 32% had Eastern Cooperative Oncology Group (ECOG) 0 or 1. The majority resided in large urban areas (55%) followed by rural (22%), moderate urban (13%), and small urban (10%). In regression analyses, smoking (hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.28-3.45, P

OBJECTIVES/HYPOTHESIS To evaluate disparities in overall survival (OS) between Asian and non-Asian patients diagnosed with non-nasopharyngeal head and neck cancer (HNC). STUDY DESIGN This was a population-based, retrospective study of patients diagnosed with non-nasopharyngeal HNC of squamous cell carcinoma histology between 2001 and 2010 in British Columbia, Canada. METHODS Using Kaplan-Meier methods and Cox regression models, we examined the relationship between race and OS. RESULTS A total of 3,036 patients were included in the study. Median age was 64 years, 74% were men, and 7% were Asians. Asians had worse Eastern Cooperative Oncology Group (ECOG) status (29% vs. 23%, P = .07) and larger tumors (33% vs. 21%, P = .02), and were more likely to be diagnosed with oral cavity cancers (38% vs. 25%, P < .001) than non-Asians. Asians were also less likely to receive multimodality therapy than non-Asians (90% vs. 95%, P = .02). Asians were more likely to have never smoked (49% vs. 15%, P < .001) and to be married or with a partner (80% vs. 69%, P = .02). Multivariate models showed that Asians had better OS than non-Asians (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.25-0.99, P = .05). Three-year OS did not differ significantly between Asians and non-Asians (41% vs. 42%, P = .18); however, 5-year OS did (22% vs. 19% P = .03). Stratifying by treatment type, outcomes were comparable in both groups except for radiotherapy alone, where Asians showed significantly better OS (HR = 0.71, 95% CI = 0.51-0.99, P = .04). Advanced age, worse ECOG, greater tumor size, and lack of treatment also correlated with inferior OS. CONCLUSIONS Despite several worse prognostic features and less aggressive treatment, Asians tended to exhibit better OS than non-Asians. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:2528-2533, 2017.

Objectives Optimal treatment of rectal cancer (RC) requires multidisciplinary care. We examined whether distance to treatment center or community size impacts access to multimodality care and population-based outcomes in RC. Methods Patients diagnosed with stage II/III RC from 1999 to 2009 and treated at 1 of 6 regional cancer centers in British Columbia were reviewed. Distance to treatment center was determined for each patient. Communities were classified as rural, small, medium, and large population centers. Logistic and Cox regression models assessed associations of distance and community size with treatment received as well as cancer-specific (CSS) and overall survival (OS). Results Of 3,158 patients, 93.6% underwent surgery, 86.3% received radiotherapy, and 51.3% were treated with adjuvant chemotherapy (AC). Median time from diagnosis to oncologic consultation was longer for those >100 km from a treatment center or residing in medium/rural communities. Logistic regression demonstrated no correlation between distance or community size and receipt of treatment modality. Univariate analysis showed similar CSS (P = .18, .88) and OS (P = .36, .47) based on community size and distance, respectively. In multivariate analysis, distance >100 km had inferior CSS (Hazard Ratio [HR] 1.39, 95% CI: 1.03-1.88; P = .031). There was no consistent trend between decreasing community size and outcomes; however, living in a small center was associated with improved OS (HR 0.58, 95% CI: 0.38-0.88; P = .011) and CSS (HR 0.42, 95% CI: 0.25-0.70; P = .001). Conclusions In this population-based study, there were no urban-rural differences in access to multidisciplinary care, but increased distance may be associated with worse cancer-specific outcomes.

Background Rural cancer survivors (RCS) potentially have unique medical and supportive care experiences when they return to their communities posttreatment because of the availability and accessibility of health services. However, there is a limited understanding of cancer survivorship in rural communities. Purpose The purpose of this study is to describe RCS experiences accessing medical and supportive care postcancer treatment. Methods Interviews and focus groups were conducted with 52 RCS residing in northern British Columbia, Canada. The data were analyzed using qualitative content analysis methods. Results General Population RCS and First Nations RCS experienced challenges accessing timely medical care close to home, resulting in unmet medical needs. Emotional support services were rarely available, and, if they did exist, were difficult to access or not tailored to cancer survivors. Travel and distance were barriers to medical and psychological support and services, not only in terms of the cost of travel, but also the toll this took on family members. Many of the RCS lacked access to trusted and useful information. Financial assistance, for follow-up care and rehabilitation services, was rarely available, as was appropriate employment assistance. Conclusion Medical and supportive care can be inaccessible, unavailable, and unaffordable for cancer survivors living in rural northern communities.

Background Adult survivors of childhood cancer (ASCC), especially those of the central nervous system (CNS), have increased risks of educational and social difficulties. It is therefore hypothesized they are more likely to encounter legal difficulties (LDs), such as workplace discrimination and disability insurance denials, which may negatively affect their quality of life (QoL). Procedure We developed a survey to collect information on patients' legal needs. QoL was assessed using the Functional Assessment of Cancer Therapy (FACT). Results We prospectively approached 112 ASCC, 111 (99.1%) of whom completed the survey. The median age of respondents was 7 years at diagnosis and 31 years at survey completion. CNS tumors were the most common malignancy (32.4%). LDs were common overall (40.7%), though more prevalent in patients with CNS versus non-CNS tumors (58.6% vs. 32.3%; P = 0.023). The most prevalent LD was workplace discrimination (58.3%). On multivariate analysis, CNS tumor was the only variable significantly associated with LDs (OR = 4.49, P = 0.041). Individuals with LDs had lower QoL scores compared to those without LDs (79.96 versus 91.83 on the FACT; P = 0.005). On multivariate analysis, individuals with LDs had lower QoL scores (14.95 points lower on the FACT), which is both clinically and statistically significant (P = 0.047). Conclusions Legal difficulties are common in adult survivors of childhood cancer, especially those with brain tumors. Furthermore, individuals with legal difficulties have worse quality of life. Research is needed to develop effective and accessible legal resource programs. Pediatr Blood Cancer 2011;56:439–443. © 2010 Wiley-Liss, Inc.

This paper addresses the need for a risk management program to provide the program level decision makers a quantitative assessment of the level of risk associated with their program. Included are the characteristics of a suitable indicator of program risk, and one approach for obtaining an assessment of program risk and making adjustments to the level of program risk.

This paper is a progress report to the NCOSE membership at large from the NCOSE Systems Architecture Working Group. The paper is intended to serve as the primary mechanism for informing the NCOSE membership of the activities completed and underway by the working group. The paper: 1) discusses motivations for establishing the group, 2) presents the group's charter, 3) provides the current definitions being used for systems architecture and some of the terms relating to systems architecture, 3) presents the working group's current view of what a systems architecture is, and the relationship of a systems architecture to the overall system and the system elements that comprise the system, 4) discusses the future plans of the working group, and 6) presents a bibliography of works that provide significant contributions to the subject of systems architecting and systems architectures.

Introduction: Contouring variability of the surgical cavity (SC) can have important implications in the planning and delivery of accelerated partial breast irradiation (APBI). This study aims to quantify the dosimetric consequences of these variations. Methods: Twelve patients with breast lesions suitable for APBI underwent four CT scans: one planning CT and three CTs during treatment. Three radiation oncologists contoured the SC on each CT. In addition, for three patients, oncologists repeated SC contouring twice to assess intraobserver variations. SC contour variability was quantified by constructing a representative SC (RSC) and calculating the standard deviation (SD) at each RSC contour point. Treatment fields from the original plan were applied to repeat CTs. The dosimetric impact of contour variations was assessed using the equivalent uniform dose (EUD) formalism. Dose‐volume constraints for normal tissues were also examined during treatment.Results: The maximum interobserver RSC SD was larger than the maximum intraobserver SD (1.50 versus 0.90 cm; p = 0.025 ). Despite these differences, there was adequate dose coverage of the SC. The SC EUD was less than 38.0 Gy in only 9.3% of CT studies. Dose‐volume constraints for the thyroid and ipsilateral lung were satisfied for all CT studies. While heart constraints were met for right‐sided lesions, they were not met for two CT studies for a left‐breast patient. Conclusions: Planning margins used for APBI provide adequate dose coverage despite contour variability. The planning dose constraint for the heart is not always met during treatment for left‐breast patients.

Purpose: To quantify interobserver and intraobserver variations in definition of the surgical cavity (SC) in the planning of accelerated partial breast irradiation (APBI). Method and Materials: Eight prospectively accrued patients underwent four CT scans each: one planning CT and three repeat CTs during treatment. Three radiation oncologists contoured the SC on each scan for all patients and repeated the contours two times on each scan for three patients. Analysis of contour variations was performed by combining the contours to create a representative surgical cavity (RSC); the volume and spatial extent of each contour was compared with the RSC. Agreement of the delineated volumes was quantified by comparing the volume enclosed by all contours with the volume common to all contours. The standard deviation at each point where the RSC was calculated was also used to assess spatial variations. Fields from the original treatment plans were applied to the repeat CTs and dose distributions in the SCs were evaluated using the equivalent uniform dose approach. Results: The average interobserver volume difference was larger than the intraobserver difference (3.09 versus 0.86 cm3). The average agreement of the delineated volumes was 15.4% better in intraobserver than in interobserver comparisons. Likewise, the average interobserver spatial differences were larger than the intraobserver differences (0.34 versus 0.11 cm in the superior‐inferior direction, 0.37 versus 0.23 cm in the anterior‐posterior direction and 0.62 versus 0.28 cm in the left‐right direction). RSC standard deviations tended to be larger for interobserver rather than intraobserver variations. Despite interobserver variations, margins used for planning appeared sufficient to achieve clinically acceptable coverage of the SC. Conclusion: Interobserver variations are most responsible for SC contour variability in APBI. Future studies investigating changes in shape or position of the SC should focus more effort accounting for interobserver rather than intraobserver variability.

LCD backlights use linear prism films to increase frontal luminance. Interaction of such periodic structures with LCD pixels leads to Moire fringes. We have developed a Moire-free platform via randomization of the prismatic microstructure. Additionally, an improvement in materials increases frontal luminance 5–10% over conventional films

Benzenesulfonate esters of hydroxyphenylbenzotriazole UV absorbers are described as UV absorber progenitors which can be used in UV-curable coating formulations. During UV exposure, they undergo a photo-Fries rearrangement to form the corresponding o-benzenesulfonyl phenol derivatives. These derivatives are formed in good chemical yield during bulk solution photolyses and are also readily formed in polymer films during exposure to sunlight. The reaction is specific for benzenesulfonate esters; little or no rearrangement takes place with benzyl, naphthyl, or alkylsulfonate esters or with benzoate esters.

Many UV-cured acrylates, epoxides, and thiol-enes suffer a dramatic, reversible loss of tensile strength during exposure to moisture and/or elevated temperatures. Certain formulations are especially sensitive and lose up to 95% of their dry tensile strength in a humid environment. Glass transition temperatures of these materials are also much lower in high humidity than they are in low humidity. It is proposed that these losses of physical properties in high humidity are due to reduced intersegmental attractions of polymer chains caused by preferential hydrogen bonding to water.

UV-curable formulations do not UV cure when hydroxybenzophenone or hydroxyphenylbenzotriazole UV screens are added to them. Reaction of these UV screens with alkyl or aryl isocyanates gives urethane derivatives in high yields. These derivatives do not impede UV cures when they are incorporated in UV-curable formulations at relatively high levels (3%–5%). After completion of the UV cure, the urethane derivatives are catalytically decomposed by heating to regenerate the corresponding UV screen within the cured coating.

Three types of lesions produced by argon laser micro-irradiation of single mitochondria are described. A correlation between lesion severity and optical phase density and/or laser output power was observed. Cell survival was generally not affected by mitochondrial irradiation. As many as ten mitochondria were irradiated without cell death resulting. Absorption of the laser radiation was attributed to the natural chromophores, cytochromes c and c1.

Studies were carried out in the greenhouse and field to elaborate the mechanism of P-Zn interaction in the nutrition of corn (Zea mays L.). From this work depressive action of P on Zn uptake of corn appears to be largely physiological in nature, expressed at root surfaces and/or in root cells, and is not chemical inactivation of Zn by P in soil. Translocation of Zn from roots to tops is inhibited by elevated P concentration, with resulting sharp reduction in Zn concentration of nodal and internodal tissues. No clearly definable P/Zn ratio in tissue was found above which yield restriction could be predicted. Corn seems to tolerate high concentrations of P in its tissues provided some modest quantity of Zn is present. Other elements counteract somewhat the damaging effects of P. Concurrently placed N promotes Zn uptake at the same time that it benefits P utilization. Increased level of native or applied K reduces the depressive effects of P on Zn.