Search results for: clinical quality

Authors: S. Sakhri

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Background: The use of Zoledronic acid (ZA) is an established place in the treatment of malignant tumors with a predilection for the skeleton of interest (in particular metastasis). Although the main target of Zoledronic acid was osteoclasts, there are preclinical data suggest that Zoledronic acid may have an antitumor effect on cells other than osteoclasts, including tumor cells. Antitumor activity, including the inhibition of tumor cell growth and the induction of apoptosis of tumor cells, inhibition of tumor cell adhesion and invasion, and anti-angiogenic effects have been demonstrated. Methods. From (2012 to 2014), 438 patients were included respondents the inclusion criteria, respectively. This is a prospective study over a 4 year period. Of all patients (N=438), 432 received neoadjuvant chemotherapy with Zoledronic acid. The primary end point was the pathologic complete response in advancer breast cancer stage. The secondary end point is to evaluate Clinical response according to RECIST criteria; estimate the bone density before and at the end of chemotherapy in women with locally advanced breast cancer, Toxicity Evaluation and Overall survival using Kaplan-Meier and log test. Result: The Objective response rate was 97% after (C4) with 3% stabilizations and 99, 3% of which 0.7% C8 after stabilization. The clinical complete response was 28% after C4 respectively, and 46.8% after C8, the pathologic complete response rate was 40.13% according to the classification Sataloff. We observed that the pathologic complete response rate was the most raised in the group including Her2 (luminal Her2 and Her2) the lowest in the triple negative group as classified by Sataloff. We found that the pCR is significantly higher in the age group (35-50 years) with 53.17%. Those who have more than 50 years in 2nd place with 27.7% and the lower in young woman 35 years pCR was 19%, not statistically significant, -The pCR was also in favor of the menopausal group in 51, 4%, and 48, 55% for non-menopausal women. The average duration of overall survival was also significantly in the subgroup (Luminal -Her2, Her2) compared with triple negative. It is 47.18 months in the luminal group vs. 38.95 in the triple negative group. -Was observed in our study a difference in quality of life between (C1) was the admission of the patient, and after (C8), we found an increase in general signs and a deterioration in the psychological state C1, in contrast to the C8 these general signs and mental status improves, up to 12, and 24 months. Conclusion The results of this study suggest that the addition of ZA to néoadjuvant CT has potential anti-cancer benefit in patients (Luminal -Her2, Her2) compared with triple negative with or without menopause status.

Keywords: HER2+, RH+, breast cancer, tyrosine kinase

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Authors: Valentina Obradović, Josip Mesić, Maja Ergović Ravančić, Kamila Mijowska, Brankica Svitlica

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French oak and American oak barrels are most famous all over the world, but barrels of different origin can also be used for obtaining high quality wines. The aim of this research was to compare the influence of different Slavonian (Croatian) and French oak barrels on the quality of Chardonnay wine. Grapes were grown in Croatian wine growing region of Kutjevo in 2015. Chardonnay wines were tested for basic oenological parameters (alcohol, extract, reducing sugar, SO2, acidity), total polyphenols content (Folin-Ciocalteu method), antioxidant activity (ABTS and DPPH method) and color density. Sensory evaluation was performed by students of viticulture/oenology. Samples produced by classical fermentation and ageing in French oak barrels, had better results for polyphenols and sensory evaluation (especially low toasting level) than samples in Slavonian barrels. All tested samples were scored as a “quality” or “premium quality” wines. Sur lie method of fermentation and ageing in Slavonian oak barrel had very good extraction of polyphenols and high antioxidant activity with the usage of authentic yeasts, while commercial yeast strain resulted in worse chemical and sensory parameters.

Keywords: chardonnay, French oak, Slavonian oak, sur lie

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Authors: Medalson Ronghang, Pranjal Barman, Heemantajeet Medhi

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Bank filtration (BF) being a natural method of abstracting surface water from the river or lake via sub-surface. It can be intensively used and operated under various operating conditions for sustainability. Field investigations were carried out at various location of Kokrajhar (Assam) and Srinagar (Uttarakhand) to assess the ground water and their bank filtration wells to compare and characterized the quality. Results obtained from the analysis of the data suggest that major water quality parameter were much below the drinking water standard of BIS 10500 (2012). However, the iron concentration was found to be more than permissible limit in more than 50% of the sampled hand pump; the concentration ranged between 0.33-3.50 mg/L with acidic in nature (5.4 to 7.4) in Kokrajhar and high nitrate in Srinagar. But the abstracted water from the RBF wells has attenuated water quality with no iron concentration in Kokrajhar. The aquifers and riverbed material collected along the bank of Rivers Gaurang and Alaknanda were sieved and classified as coarse silt to medium gravel. The hydraulic conductivity was estimated in the range 5×10⁻³ to 1.4×10⁻²- 3.09×10⁻⁴-1.29 ×10⁻³ for Kokrajhar and Srinagar respectively suggesting a good permeability of the aquifer. The maximum safe yield of the well was estimated to be in the range of 4000 to 7500 L/min. This paper aims at demonstrating bank filtration method as an alternative to mineralized groundwater for drinking water.

Keywords: Riverbank filtration, mineralization, water quality, groundwater

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Authors: Bui Phuong Linh, Yuki Sakakibara, Ryuto Tanaka, Elizabeth H. Pigney, Taishi Hashiguchi

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Non-alcoholic steatohepatitis (NASH) is a chronic liver disease, often associated with type II diabetes, which sometimes progresses to more serious conditions such as liver fibrosis and hepatocellular carcinoma (HCC). NASH has become an important health problem worldwide, buttherapeutic agents for NASH have not yet been approved, and animal models with high clinical correlation are required. TheSTAM™ mouse shows the same pathological progression as human NASH patients and has been widely used for both drug efficacy and basic research, such as lipid profiling and gut microbiota research. In this study, we analyzed the RNA-seq data of STAM™mice at each pathological stage (steatosis, steatohepatitis, liver fibrosis, and HCC) and examined the clinical correlation at the genetic level. NASH was induced in male mice by a single subcutaneous injection of 200 µg streptozotocin solution 2 days after birth and feeding with high fat dietafter 4 weeks of age. The mice were sacrificed and livers collected at 6, 8, 10, 12, 16, and 20 weeks of age. For liver samples, the left lateral lobe was snap frozen in liquid nitrogen and stored at -80˚C for RNA-seq analysis. Total RNA of the cells was isolated using RNeasy mini kit. The gene expression of the canonical pathways in NASH progression from steatosis to hepatocellular carcinoma were analyzed, such as immune system process, oxidation-reduction process, lipid metabolic process. Moreover, since it has been reported that genetic traits are involved in the development of NASH-HCC, we next analyzed the genetic mutations in the STAM™mice. The number of individuals showing mutations in Mtorinvolved in Insulin signaling increases as the disease progresses, especially in the liver cancer phase. These results indicated a clinical correlation of gene profiles in the STAM™mouse.

Keywords: steatosis, non-alcoholic steatohepatitis, fibrosis, hepatocellular carcinoma, RNA-seq

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Authors: Shazia Anwer Bukhari, Madiha Javeed Ghani, Muhammad Ibrahim Rajoka

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Objective: Biochemical, environmental, physical and genetic factors have a strong effect on the development of coronary disease (CAD). Plasma homocysteine (Hcy) level and DNA damage play a pivotal role in its development and progression. The aim of this study was to investigate the predictive strength of an oxidative stress, clinical biomarkers and total antioxidant status (TAS) in CAD patients to find the correlation of homocysteine, TOS and oxidative DNA damage with other clinical parameters. Methods: Sixty confirmed patients with CAD and 60 healthy individuals as control were included in this study. Different clinical and laboratory parameters were studied in blood samples obtained from patients and control subjects using commercially available biochemical kits and statistical software Results: As compared to healthy individuals, CAD patients had significantly higher concentrations of indices of oxidative stress: homocysteine (P=0.0001), total oxidative stress (TOS) (P=0.0001), serum cholesterol (P=0.04), low density lipoprotein cholesterol (LDL) (P=0.01), high density lipoprotein-cholesterol (HDL) (P=0.0001), and malondialdehyde (MDA) (P=0.001) than those of healthy individuals. Plasma homocysteine level and oxidative DNA damage were positively correlated with cholesterol, triglycerides, systolic blood pressure, urea, total protein and albumin (P values= 0.05). Both Hcy and oxidative DNA damage were negatively correlated with TAS and proteins. Conclusion: Coronary artery disease patients had a significant increase in homocysteine level and DNA damage due to increased oxidative stress. In conclusion, our study shows a significantly increase in lipid peroxidation, TOS, homocysteine and DNA damage in the erythrocytes of patients with CAD. A significant decrease level of HDL-C and TAS was observed only in CAD patients. Therefore these biomarkers may be useful diagnosis of patients with CAD and play an important role in the pathogenesis of CAD.

Keywords: antioxidants, coronary artery disease, DNA damage, homocysteine, oxidative stress, malondialdehyde, 8-Hydroxy-2’deoxyguanosine

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Authors: Gatot Ciptadi, Mudawamah, R. P. Putra, S. Wahjuningsih, A. M. Munazaroh

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The success rate of Artificial Insemination (AI) application, particularly in the field at the farmer level is highly dependent on the quality of the sperms one post thawing. The objective of this research was to determine the effect of freezing method (-1oC/ minute) using Mr. Frosty system with commercial diluents on the post-thawing quality of Boer goat semen. Method use is experimental design with the completely randomized design (CRD) with 4 treatments of commercial diluter percentage (v/v). Freezing semen was cryopreserved in 2 main final temperatures of –45 oC (Freezer) and –196 oC (liquid nitrogen). Result showed that different commercial diluter is influenced on viability motility and abnormalities of Boer semen. Pre-freezing qualities of viability, motilities and abnormalities was 88.67+4.16 %, 66.33 +1.53 % and 4.67+ 0.57 % respectively. Meanwhile, post-thawing qualities is considered as good as standard qualities at least more than 40 % (51.0+6.5%). The percentage of commercial diluents were influenced highly significant (P<0.01).The best diluents ration is 1:4 (v/v) for both final sperms stocked. However freezing sperm conserved in -196 oC is better than –45 oC (i.e. motility 39.3.94 % vs. 51.0 + 6.5 %). It was concluded that Mr. frosty system was considered as the feasible method for freezing semen in the reason for practical purposes.

Keywords: sperm quality, goat, viability, diluteR

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Authors: K. Y. Chen, H. Chua, C. W. Kan

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In this study, we will analyze Germany’s environmental situation such as water and air quality and review its environmental policy. In addition, we will collect the yearly environmental data as well as information concerning public environmental investment. Based on the data collect, we try to find out the relationship between public environmental investment and sustainable development in Germany. In addition, after comparing the trend of environmental quality and situation of environmental policy and investment, we may have some conclusions and learnable aspects to refer to. Based upon the data collected, it was revealed that Germany has established a well-developed institutionalization of environmental education. And the ecological culture at school is dynamic and continuous renewal. The booming of green markets in Germany is a very successful experience for learning. The green market not only creates a number of job opportunities, but also helps the government to improve and protect the environment. Acknowledgement: Authors would like to thank the financial support from the Hong Kong Polytechnic University for this work.

Keywords: Germany, public environmental investment, environment quality, sustainable development

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Authors: Mansoor Soomro

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The evolution of power electronic equipment has been pivotal in making industrial processes productive, efficient and safe. Despite its attractive features, it has been due to nonlinear loads which make it vulnerable to power quality conditions. Harmonics is one of the power quality problem in which the harmonic frequency is integral multiple of supply frequency. Therefore, the supply voltage and supply frequency do not last within their tolerable limits. As a result, distorted current and voltage waveform may appear. Attributes of low power quality confirm that an electrical device or equipment is likely to malfunction, fail promptly or unable to operate under all applied conditions. The electrical power system is designed for delivering power reliably, namely maximizing power availability to customers. However, power quality events are largely untracked, and as a result, can take out a process as many as 20 to 30 times a year, costing utilities, customers and suppliers of load equipment, a loss of millions of dollars. The ill effects of current harmonics reduce system efficiency, cause overheating of connected equipment, result increase in electrical power and air conditioning costs. With the passage of time and the rapid growth of power electronic converters has highlighted the damages of current harmonics in the electrical power system. Therefore, it has become essential to address the bad influence of current harmonics while planning any suitable changes in the electrical installations. In this paper, an effort has been made to mitigate the effects of dominant 3rd order current harmonics. Passive filtering technique with six pulse multiplication converter has been employed to mitigate them. Since, the standards of power quality are to maintain the supply voltage and supply current within certain prescribed standard limits. For this purpose, the obtained results are validated as per specifications of IEEE 519-1992 and IEEE 519-2014 performance standards.

Keywords: current harmonics, power quality, passive filters, power electronic converters

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Authors: Vanessa Roulet, Marc Turini, Juliane Hey, Stéphanie Bord-Romeu, Emilie Bonzom, Mahmoud Badawi, Mohammed-Amine Chakir, Valérie Simon, Vanessa Viotti, Jérémie Gautier, Françoise Le Boulaire, Catherine Coignard, Claire Vincent, Sandrine Greaume, Isabelle Voisin

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Background: Beckman Coulter, Inc. has recently developed fully automated assays for the detection of HBsAg on a new immunoassay platform. The objective of this European multicenter study was to evaluate the performance of the ACCESS HBsAg and ACCESS HBsAg Confirmatory assays† on the recently CE-marked DxI 9000 ACCESS Immunoassay Analyzer. Methods: The clinical specificity of the ACCESS HBsAg and HBsAg Confirmatory assays was determined using HBsAg-negative samples from blood donors and hospitalized patients. The clinical sensitivity was determined using presumed HBsAg-positive samples. Sample HBsAg status was determined using a CE-marked HBsAg assay (Abbott ARCHITECT HBsAg Qualitative II, Roche Elecsys HBsAg II, or Abbott PRISM HBsAg assay) and a CE-marked HBsAg confirmatory assay (Abbott ARCHITECT HBsAg Qualitative II Confirmatory or Abbott PRISM HBsAg Confirmatory assay) according to manufacturer package inserts and pre-determined testing algorithms. False initial reactive rate was determined on fresh hospitalized patient samples. The sensitivity for the early detection of HBV infection was assessed internally on thirty (30) seroconversion panels. Results: Clinical specificity was 99.95% (95% CI, 99.86 – 99.99%) on 6047 blood donors and 99.71% (95%CI, 99.15 – 99.94%) on 1023 hospitalized patient samples. A total of six (6) samples were found false positive with the ACCESS HBsAg assay. None were confirmed for the presence of HBsAg with the ACCESS HBsAg Confirmatory assay. Clinical sensitivity on 455 HBsAg-positive samples was 100.00% (95% CI, 99.19 – 100.00%) for the ACCESS HBsAg assay alone and for the ACCESS HBsAg Confirmatory assay. The false initial reactive rate on 821 fresh hospitalized patient samples was 0.24% (95% CI, 0.03 – 0.87%). Results obtained on 30 seroconversion panels demonstrated that the ACCESS HBsAg assay had equivalent sensitivity performances compared to the Abbott ARCHITECT HBsAg Qualitative II assay with an average bleed difference since first reactive bleed of 0.13. All bleeds found reactive in ACCESS HBsAg assay were confirmed in ACCESS HBsAg Confirmatory assay. Conclusion: The newly developed ACCESS HBsAg and ACCESS HBsAg Confirmatory assays from Beckman Coulter have demonstrated high clinical sensitivity and specificity, equivalent to currently marketed HBsAg assays, as well as a low false initial reactive rate. †Pending achievement of CE compliance; not yet available for in vitro diagnostic use. 2023-11317 Beckman Coulter and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. All other trademarks are the property of their respective owners.

Keywords: dxi 9000 access immunoassay analyzer, hbsag, hbv, hepatitis b surface antigen, hepatitis b virus, immunoassay

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Authors: Dejan Tanikić, Jelena Đoković, Saša Kalinović, Miodrag Manić, Saša Ranđelović

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This paper deals with measuring and modelling of the quality of the machined surface of the metal machining process. The average surface roughness (R_a) which represents the quality of the machined part was measured during the dry turning of the AISI 4140 steel. A large number of factors with the unknown relations among them influences this parameter, and that is why mathematical modelling is extremely complicated. Different values of cutting speed, feed rate, depth of cut (cutting regime) and workpiece hardness causes different surface roughness values. Modelling with soft computing techniques may be very useful in such cases. This paper presents the usage of the fuzzy logic-based system for determining metal machining process parameter in order to find the proper values of cutting regimes.

Keywords: fuzzy logic, metal machining, process modeling, surface roughness

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Authors: Rakan Alajmi, Rahaf Alnazzawi, Yara Aljefri, Abdullah Alafif, Ali Alraddadi, Awadh Alamri

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Background: The distribution of physicians in different specialties across Saudi Arabia is determined by the career choices of medical students. Dermatology residency program is one of the highly competitive programs here in Saudi Arabia. Assessing and understanding the factors perceived to be attractive in choosing dermatology will aid the directors of the specialty programs to plan for a more balanced workforce distribution to better suit the needs of the specialties. Aim: The aim of our study is to determine and assess the factors perceived to be significantly attractive when choosing dermatology as a future specialty. Methods: The study is a cross-sectional study conducted in King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. A validated questionnaire was sent electronically to clinical year medical students. In addition to the questionnaire, gender, grade point average, preferred specialty, and other socio-demographic data were assessed. Results: A total of 121 clinical years medical students completed the questionnaire, 8 (6.6%) preferred dermatology as a specialty. 76 (62.8%) of the participants score a grade point average of more than 4.5 and 83 students (68.6%) chose their specialty during clinical years. The appeal of being a dermatologist (P= 0.047), the portrayal of different specialities in the media (P= 0.005), and the likelihood that dermatologists can influence patients’ lives (P=0.010) were shown to be significantly attractive factors. Conclusion: There are many factors that are affecting students’ choices when choosing a medical specialty. The appeal of being a dermatologist, the portrayal of different specialities in the media, and the likelihood that dermatologists can influence patients’ lives were shown to be significantly attractive factors when choosing dermatology as a future specialty. Recognizing medical students’ specialty perception will lead them to a proper specialty tailored to their needs.

Keywords: dermatology, career choice, medical specialties, student's perception

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Authors: L. Belkhiri, L. Mouni, A. Tiri, T.S. Narany

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In the present study, the self-organizing map (SOM) clustering technique was applied to identify homogeneous clusters of hydrochemical parameters in El Milia plain, Algeria, to assess the quality of groundwater for potable and agricultural purposes. The visualization of SOM-analysis indicated that 35 groundwater samples collected in the study area were classified into three clusters, which showed progressive increase in electrical conductivity from cluster one to cluster three. Samples belonging to cluster one are mostly located in the recharge zone showing hard fresh water type, however, water type gradually changed to hard-brackish type in the discharge zone, including clusters two and three. Ionic ratio studies indicated the role of carbonate rock dissolution in increases on groundwater hardness, especially in cluster one. However, evaporation and evapotranspiration are the main processes increasing salinity in cluster two and three.

Keywords: groundwater quality, self-organizing maps, drinking water, irrigation water

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Authors: Kamran Yazdanbakhsh, Somayeh Mahmoudi

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Multiple sclerosis is the most common chronic disease of the central nervous system associated with demyelination of neurons and several demyelinated parts of the disease encompasses throughout the white matter and affects the sensory and motor function. This study compared the effectiveness of two methods of cognitive therapy and supportive-expressive therapy on the efficacy and quality of life in MS patients. This is an experimental project which has used developed group pretest - posttest and follow-up with 3 groups. The study included all patients with multiple sclerosis in 2013 that were members of the MS Society of Iran in Tehran. The sample included 45 patients with MS that were selected volunteerily of members of the MS society of Iran and randomly divided into three groups and pretest, posttest, and follow-up (three months) for the three groups had been done.The dimensions of quality of life in patients with multiple sclerosis scale, and general self-efficiency scale of Schwarzer and Jerusalem was used for collecting data. The results showed that there was a significant difference between the mean of quality of life scores at pretest, posttest, and follow-up of the experimental groups. There was no significant difference between the mean of quality of life of the experimental groups which means that both groups were effective and had the same effect. There was no significant difference between the mean of self-efficiency scores in control and experimental group in pretest, posttest and follow-up. Thus, by using cognitive and supportive-expressive group therapy we can improve quality of life in MS patients and make great strides in their mental health.

Keywords: cognitive group therapy, life style, MS, self-efficiency, supportive-expressive group therapy

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Authors: Saeedeh Eshkil, Seyedeh Farnaz Mousavi, Hamid Reza Kianifar, Seyed Java Sayyedi, Mehdi Sohrabi, Elham Bakhtiari, Morteza Mashoughi, Ezzat Khodashenas

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Background: The effect of the SPARK physical education program on lung function in cystic fibrosis patients is not yet determined.).SPARK is Sports, play and active recreation for kids, including moving skills, aerobic games, jogging or walking, aerobic dance and jump rope. Regarding the high prevalence of cystic fibrosis and its destructive effects on the lungs, the aim of this study is to evaluate lung function and quality of life before and after undergoing the SPARK physical education program in children with cystic fibrosis. Method: In this quasi-experimental study, all patients with cystic fibrosis aged 6-18 years referred to the cystic fibrosis clinic of Dr. Sheikh Hospital were enrolled. The patients went under 12 weeks of SPARK training program (3 sessions per week, each session 45 minutes). The quality of life questionnaire ( Cystic Fibrosis Questionnaire includes self-examination, parental ) for patients with cystic fibrosis and spirometry indices (FEV1, FVC, FEV1/FVC, FEF25-75) was filled out before and after intervention for all patients. Results The mean and standard deviation of patients' age were 9.85±2.67 years, and 65% of patients were female. The FEV1 was significantly different before and after the SPARK physical education program (P=0.03), and the respiratory component of quality of life significantly increased after intervention (P=0.002). The overall score of quality of life from parents’ point of view was 2.87 ± 0.38, which increased to 2.99 ± 0.38 after the intervention. Conclusion: The SPARK training program may improve the spirometric parameters in children with cystic fibrosis. It also had a significant effect on improving the quality of life of patients, especially in the respiratory component.

Keywords: cystic fibrosis, pediatrics, SPARK motor program, spirometry

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Authors: C. Nathanailides, S. Anastasiou, A. Dimitroglou, P. Logothetis, G. Kanlis

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In the present work we reviewed historical data of the Greek Marine aquaculture industry including adoption of new methods and technological innovation. The results indicate that the industry exhibited a rapid rise in production efficiency, employment and adoption of new technologies which reduced outbreaks of diseases, reduced production risk and the price of the farmed fish. The improvements of total quality practices and technological input on the Greek Aquaculture industry include improved survival, growth and body shape of farmed fish, which resulted from development of new aquaculture feeds and the genetic selection of the bloodstock. Also improvements in the quality of the final product were achieved via technological input in the methods and technology applied during harvesting, packaging, and transportation-preservation of farmed fish ensuring high quality of the product from the fish farm to the plate of the consumers. These parameters (health management, nutrition, genetics, harvesting and post-harvesting methods and technology) changed significantly over the last twenty years and the results of these improvements are reflected in the production efficiency of the Aquaculture industry and the quality of the final product. It is concluded that the Greek aquaculture industry exhibited a rapid growth, adoption of technologies and supply was stabilized after the global financial crisis, nevertheless, the development of the Greek aquaculture industry is currently limited by international trade sanctions, credit crunch, and increased taxation and not by limited technology or resources.

Keywords: innovation, aquaculture, total quality, management

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Authors: Suwarno, M. Helmi Prakoso

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Mineral oil is commonly used for high voltage transformer insulation. The insulation quality of mineral oil is affecting the operation process of high voltage transformer. There are many contaminations which could decrease the insulation quality of mineral oil. One of them is water. This research talks about the effect of water content on dielectric properties, physic properties, and partial discharge pattern on mineral oil. Samples were varied with 10 varieties of water content value. And then all samples were tested to measure the dielectric properties, physic properties, and partial discharge pattern. The result of this research showed that an increment of water content value would decrease the insulation quality of mineral oil.

Keywords: dielectric properties, high voltage transformer, mineral oil, water content

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Authors: Himansu, Bedanga Talukdar

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The aim of present study is to investigate the prevalence of various health outcomes and quality of life and analyzes the moderating role of social capital on health outcomes (i.e., self-rated good health (SRH), depression, functional health and quality of life) among elderly in India. Using WHO Study on Global AGEing and adults health (SAGE) data, with sample of 6559 elderly between 50 and above (Mage=61.81, SD=9.00) age were selected for analysis. Multivariate analysis accessed the prevalence of SRH, depression, functional limitation and quality of life among older adults. Logistic regression evaluates the effect of social capital along with other co-founders on SRH, depression, and functional limitation, whereas linear regression evaluates the effect of social capital with other co-founders on quality of life (QoL) among elderly. Empirical results reveal that (74%) of respondents were married, (70%) having low social action, (46%) medium sociability, (45%) low trust-solidarity, (58%) high safety, (65%) medium civic engagement and 37% reported medium psychological resources. The multivariate analysis, explains (SRH) is associated with age, female, having education, higher social action great trust, safety and greater psychological resources. Depression among elderly is greatly related to age, sex, education and higher wealth, higher sociability, having psychological resources. QoL is negatively associated with age, sex, being Muslim, whereas positive associated with higher education, currently married, civic engagement, having wealth, social action, trust and solidarity, safeness, and strong psychological resources.

Keywords: depressive symptom, functional limitation, older adults, quality of life, self rated health, social capital

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Authors: Meenakshi Barsaul Chauhan, Aastha Chauhan, Shilpa Hurmade, Rajeev Sen, Jyotsna Sen, Monika Dalal

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Introduction: Ovarian masses are common forms of neoplasm in women and represent 2/3rd of gynaecological malignancies. A pre-operative suggestion of malignancy can guide the gynecologist to refer women with suspected pelvic mass to a gynecological oncologist for appropriate therapy and optimized treatment, which can improve survival. In the younger age group preoperative differentiation into benign or malignant pathology can decide for conservative or radical surgery. Imaging modalities have a definite role in establishing the diagnosis. By using International Ovarian Tumor Analysis (IOTA) classification with sonography, costly radiological methods like Magnetic Resonance Imaging (MRI) / computed tomography (CT) scan can be reduced, especially in developing countries like India. Thus, this study is being undertaken to evaluate the role of clinical methods and sonography for diagnosis of the nature of the ovarian tumor. Material And Methods: This prospective observational study was conducted on 40 patients presenting with ovarian masses, in the Department of Obstetrics and Gynaecology, at a tertiary care center in northern India. Functional cysts were excluded. Ultrasonography and color Doppler were performed on all the cases.IOTA rules were applied, which take into account locularity, size, presence of solid components, acoustic shadow, dopper flow etc . Magnetic Resonance Imaging (MRI) / computed tomography (CT) scans abdomen and pelvis were done in cases where sonography was inconclusive. In inoperable cases, Fine needle aspiration cytology (FNAC) was done. The histopathology report after surgery and cytology report after FNAC was correlated statistically with the pre-operative diagnosis made clinically and sonographically using IOTA rules. Statistical Analysis: Descriptive measures were analyzed by using mean and standard deviation and the Student t-test was applied and the proportion was analyzed by applying the chi-square test. Inferential measures were analyzed by sensitivity, specificity, negative predictive value, and positive predictive value. Results: Provisional diagnosis of the benign tumor was made in 16(42.5%) and of the malignant tumor was made in 24(57.5%) patients on the basis of clinical findings. With IOTA simple rules on sonography, 15(37.5%) were found to be benign, while 23 (57.5%) were found to be malignant and findings were inconclusive in 2 patients (5%). FNAC/Histopathology reported that benign ovarian tumors were 14 (35%) and 26(65%) were malignant, which was taken as the gold standard. The clinical finding alone was found to have a sensitivity of 66.6% and a specificity of 90.9%. USG alone had a sensitivity of 86% and a specificity of 80%. When clinical findings and IOTA simple rules of sonography were combined (excluding inconclusive masses), the sensitivity and specificity were 83.3% and 92.3%, respectively. While including inconclusive masses, sensitivity came out to be 91.6% and specificity was 89.2. Conclusion: IOTA's simple sonography rules are highly sensitive and specific in the prediction of ovarian malignancy and also easy to use and easily reproducible. Thus, combining clinical examination with USG will help in the better management of patients in terms of time, cost and better prognosis. This will also avoid the need for costlier modalities like CT, and MRI.

Keywords: benign, international ovarian tumor analysis classification, malignant, ovarian tumours, sonography

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Authors: Hossam N. Alhawatmeh, Areen I. Albustanji

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Hemodialysis negatively affects physical and psychological health. Pain, poor sleep quality, and low self-esteem are highly prevalent among patients with end-stage renal disease (ESRD) who receive hemodialysis, significantly increasing mortality and morbidity of those patients. Mind-body interventions (MBI), such as mindfulness meditation, have been recently gaining popularity that improved pain, sleep quality, and self-esteem in different populations. However, to our best knowledge, its effects on these health problems in patients receiving hemodialysis have not been studied in Jordan. Thus, the purpose of the study was to examine the effect of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESR receiving hemodialysis in Jordan. An experimental repeated-measures, randomized, parallel control design was conducted on (n =60) end-stage renal disease patients undergoing hemodialysis between March and June 2023 in the dialysis center at a public hospital in Jordan. Participants were randomly assigned to the experimental (n =30) and control groups (n =30) using a simple random assignment method. The experimental group practiced mindfulness meditation for 30 minutes three times per week for five weeks during their hemodialysis treatments. The control group's patients continued to receive hemodialysis treatment as usual for five weeks during hemodialysis sessions. The study variables for both groups were measured at baseline (Time 0), two weeks after intervention (Time 1), and at the end of intervention (Time 3). The numerical rating scale (NRS), the Rosenberg Self-Esteem Scale (RSES-M), and the Pittsburgh Sleep Quality Index (PSQI) were used to measure pain, self-esteem, and sleep quality, respectively. SPSS version 25 was used to analyze the study data. The sample was described by frequency, mean, and standard deviation as an appropriate. The repeated measures analysis of variance (ANOVA) tests were run to test the study hypotheses. The results of repeated measures ANOVA (within-subject) revealed that mindfulness meditation significantly decrease pain by the end of the intervention in the experimental group. Additionally, mindfulness meditation improved sleep quality and self-esteem in the experimental group, and these improvements occurred significantly after two weeks of the intervention and at the end of the intervention. The results of repeated measures ANOVA (within and between-subject) revealed that the experimental group, compared to the control group, experienced lower levels of pain and higher levels of sleep quality and self-esteem over time. In conclusion, the results provided substantial evidence supporting the positive impacts of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESRD undergoing hemodialysis. These results highlight the potential of mindfulness meditation as an adjunctive therapy in the comprehensive care of this patient population. Incorporating mindfulness meditation into the treatment plan for patients receiving hemodialysis may contribute to improved well-being and overall quality of life.

Keywords: hemodialysis, pain, sleep quality, self-esteem, mindfulness

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Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: Rasheed A. Adebayo, Mehluli M. Moyo, Ignatius V. Nsahlai

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Ruminants are known to relish roughage for productivity but the effect of its quality on digesta load in rumen, omasum, abomasum and other distal organs of the digestive tract is yet unknown. Reticulorumen fill is a strong indicator for long-term control of intake in ruminants. As such, the measurement and prediction of digesta load in these compartments may be crucial to productivity in the ruminant industry. The current study aimed at determining the effect of (a) diet quality on digesta load in digestive organs of goats, and (b) period of meal termination on the reticulorumen fill and digesta load in other distal compartments of the digestive tract of goats. Goats were fed with urea-treated hay (UTH), urea-sprayed hay (USH) and non-treated hay (NTH). At the end of eight weeks of a feeding trial period, upon termination of a meal in the morning, afternoon or evening, all goats were slaughtered in random groups of three per day to measure reticulorumen fill and digesta loads in other distal compartments of the digestive tract. Both diet quality and period affected (P < 0.05) the measure of reticulorumen fill. However, reticulorumen fill in the evening was larger (P < 0.05) than afternoon, while afternoon was similar (P > 0.05) to morning. Also, diet quality affected (P < 0.05) the wet omasal digesta load, wet abomasum, dry abomasum and dry caecum digesta loads but did not affect (P > 0.05) both wet and dry digesta loads in other compartments of the digestive tract. Period of measurement did not affect (P > 0.05) the wet omasal digesta load, and both wet and dry digesta loads in other compartments of the digestive tract except wet abomasum digesta load (P < 0.05) and dry caecum digesta load (P < 0.05). Both wet and dry reticulorumen fill were correlated (P < 0.05) with omasum (r = 0.623) and (r = 0.723), respectively. In conclusion, reticulorumen fill of goats decreased by improving the roughage quality; and the period of meal termination and measurement of the fill is a key factor to the quantity of digesta load.

Keywords: digesta, goats, meal termination, reticulo-rumen fill

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Authors: Sung Ham, Chanho Song, Jiabin Wu

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Employees are commonly incentivized on both quantity and quality performance and much of the extant literature focuses on demonstrating that multitasking incentives lead to tradeoffs. Alternatively, we consider potential solutions to the tradeoff problem from both a theoretical and an experimental perspective. Across two field experiments from a call center, we find that tradeoffs can be mitigated when incentives are jointly enhanced across tasks, where previous research has suggested that incentives be reduced instead of enhanced. In addition, we also propose and test, in a laboratory setting, the implications of revising the metric used to assess quality. Our results indicate that metrics can be adjusted to align quality and quantity more efficiently. Thus, this alignment has the potential to thwart the classic tradeoff problem. Finally, we validate our findings with an economic experiment that verifies that effort is largely consistent with our theoretical predictions.

Keywords: incentives, multitasking, field experiment, experimental economics

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Authors: Dora Bianchi, Anthony Schinelli, Laura Maria Fatta, Antonia Lonigro, Fabio Lucidi, Fiorenzo Laghi

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Purpose: The role of body image in adolescent binge eating is widely confirmed, albeit the various facets of this relationship are still mostly unexplored. Within the multidimensional body image framework, this study hypothesized the indirect effects of three body image coping strategies (positive rational acceptance, appearance fixing, avoidance) in the expected relationship between the perceived impact of body image on individuals’ quality of life and binge eating symptoms. Methods: Participants were 715 adolescents aged 15-21 years (49.1% girls) recruited in Italian schools. An anonymous self-report online survey was administered. A multiple mediation model was tested. Results: A more positive perceived impact of body image on quality of life was a negative predictor of adolescents’ binge eating, controlling for individual levels of body satisfaction. Three indirect effects were found in this relationship: on one hand, the positive body image impact reduced binge eating via increasing positive rational acceptance (M1), and via reducing avoidance (M2); on the contrary, the positive body image impact also enhanced binge eating via increasing appearance fixing (M3). Conclusions: The body image impact on quality of life can be alternatively protective—when adaptive coping is solicited, and maladaptive strategies are reduced—or a risk factor, which may increase binge eating by soliciting appearance fixing.

Keywords: binge eating, body image satisfaction, quality of life, coping strategies, adolescents

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Authors: Corbel Camille, Le Cerf Flora, Corveleyn Xavier

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Introduction: Aging is a physiological phenomenon accompanied by anatomical and cognitive changes leading to anxiety and pain. This could have significant impacts on quality of life, life expectancy, and the progression of cognitive disorders. Virtual Reality Intervention (VRI) is increasingly recognized as a non-pharmacological approach to alleviate pain and anxiety in children and young adults. However, while recent studies have explored the feasibility of applying VRI in the older population, confirmation through studies is still required to establish its benefits in various contexts. Objective: This pilot study, following a clinical trial methodology international recommendation for VRI in healthcare, aims to evaluate the feasibility and effects of using VRI with a 101-year-old woman residing in a nursing home undergoing weekly painful and anxious wound dressing changes. Methods: Following the international recommendations, this study focused on feasibility and preliminary results. A Single Case Experimental Design protocol consists of two distinct phases: control (Phase A) and personalized VRI (Phase B), each lasting for 6 sessions. Data were collected before, during and after the care, using measures of pain (Algoplus and numerical scale), anxiety (Hospital anxiety scale and numerical scale), VRI experience (semi-structured interview) and physiological measures. Results: The results suggest that the utilization of VRI is both feasible and well-tolerated by the participant. VRI contributed to a decrease in pain and anxiety during care sessions, with a more significant impact on pain compared to anxiety, which showed a gradual and slight decrease. Physiological data, particularly those related to stress, also indicate a reduction in physiological activity during VRI. Conclusion: This pilot study confirms the feasibility and benefits of using virtual reality in managing pain and anxiety in an older adult in a nursing home. In light of these results, it is essential that future studies focus on setting up randomized controlled trials (RCTs). These studies should involve a representative number of older adults to ensure generalizable data. This rigorous, controlled methodology will enable us to assess the effectiveness of virtual reality more accurately in various care settings, measure its impact on clinical parameters such as pain and anxiety, and explore the long-term implications of this intervention.

Keywords: anxiety reduction, nursing home, older adult, pain management, virtual reality

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Authors: Fstemeh Rais Esmaili, Ehsan Ranjbar

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Pedestrian streets as one type of urban public spaces have an important role in improving the quality of urban life. In Iran, planning and designing of pedestrian streets is in its primary steps. In spite of starting this approach in Iran, and designing several pedestrian streets, there are still not organized studies about quality assessment of pedestrian streets. As a result, the strength and weakness points of the initial experiences have not been utilized. This inattention to quality assessment have caused designing pedestrian streets to be limited to just vehicles traffic control and preliminary actions like paving; so that, special potentials of pedestrian streets for creating social, livable and dynamic public spaces have not been used. This article, as an organized study about quality assessment of pedestrian streets in Iran, tries to reach two main goals: first, introducing a framework for quality assessment of pedestrian streets in Iran, and second, creating a context for improving the quality of pedestrian streets especially for further experiences. The main research methods are description and context analyzing. With respect to comparative analysis of ideas about quality, considering international and local case studies and analyzing existing condition of Saf Pedestrian Street, a particular model for quality assessment has been introduced. In this model, main components and assessment criteria have been presented. On the basis of this model, questionnaire and checklist for assessment have been prepared. The questionnaire and interview have been used to assess qualities which are in direct contact with people and the checklist has been used for analyzing visual qualities by authors through observation. Some results of questionnaire and checklist show that 7 of 11 primary components, diversity, flexibility, cleanness, legibility and imaginably, identity, livability, form and physical setting are rated low and very low in quality degree. Three components, efficiency, comfort and distinctiveness, have medium and low quality degree and one component, access, linkage and permeability has high quality degree. Therefore, based on implemented analyzing process, Saf Pedestrian Street needs to be improved and these quality improvement priorities are determined based on presented criteria. Adaption of final results with existing condition illustrates the shortage of services for satisfying user’s needs, inflexibility and impossibility of using spaces in various times, lack of facilities for different climatic conditions, lack of facilities such as drinking fountain, inappropriate designing of existing urban furniture like garbage cans, and creating pollution and unsuitable view, lack of visual attractions, neglecting disabled persons in designing entrances, shortage of benches and their undesirable designing, lack of vegetation, absence of special characters making it different from other streets, preventing people taking part in the space causing lack of affiliation, lack of appropriate elements for leisure time and lack of exhilaration in the space. On the other hand, these results present high access and permeability, high safety, less sound pollution and more relief, comfortable movement along the way due to suitable pavement and economic efficiency, as the strength points of Saf pedestrian street.

Keywords: pedestrian streets, quality assessment, quality criteria, Saf Pedestrian Street

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Authors: Yun-Hsiang Lee

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Cancer is the main cause of death worldwide. With advances in medical technology, immunotherapy, which is a newly developed advanced treatment, is currently a crucial cancer treatment option. For better quality cancer care, the ability to communicate and critical thinking plays a central role in clinical oncology settings. However, few studies have explored the impact of communication skills on immunotherapy-related issues and their related factors. This study was to (i) explore the current status of communication skill ability for immunotherapy-related issues, self-efficacy for immunotherapy-related care, and critical thinking ability; and (ii) identify factors related to communication skill ability. This is a cross-sectional study. Oncology nurses were recruited from the Taiwan Oncology Nursing Society, in which nurses came from different hospitals distributed across four major geographic regions (North, Center, South, East) of Taiwan. A total of 123 oncology nurses participated in this study. A set of questionnaires were used for collecting data. Communication skill ability for immunotherapy issues, self-efficacy for immunotherapy-related care, critical thinking ability, and background information were assessed in this survey. Independent T-test and one-way ANOVA were used to examine different levels of communication skill ability based on nurses having done oncology courses (yes vs. no) and education years (< 1 year, 1-3 years, and > 3 years), respectively. Spearman correlation was conducted to understand the relationships between communication skill ability and other variables. Among the 123 oncology nurses in the current study, the majority of them were female (98.4%), and most of them were employed at a hospital in the North (46.8%) of Taiwan. Most of them possessed a university degree (78.9%) and had at least 3 years of prior work experience (71.7%). Forty-three of the oncology nurses indicated in the survey that they had not received oncology nurses-related training. Those oncology nurses reported moderate to high levels of communication skill ability for immunotherapy issues (mean=4.24, SD=0.7, range 1-5). Nurses reported moderate levels of self-efficacy for immunotherapy-related care (mean=5.20, SD=1.98, range 0-10) and also had high levels of critical thinking ability (mean=4.76, SD=0.60, range 1-6). Oncology nurses who had received oncology training courses had significantly better communication skill ability than those who had not received oncology training. Oncology nurses who had higher work experience (1-3 years, or > 3 years) had significantly higher levels of communication skill ability for immunotherapy-related issues than those with lower work experience (<1 year). When those nurses reported better communication skill ability, they also had significantly better self-efficacy (r=.42, p<.01) and better critical thinking ability (r=.47, p<.01). Taken altogether, courses designed to improve communication skill ability for immunotherapy-related issues can make a significant impact in clinical settings. Communication skill ability for oncology nurses is the major factor associated with self-efficacy and critical thinking, especially for those with lower work experience (< 1 year).

Keywords: communication skills, critical thinking, immunotherapy, oncology nurses, self-efficacy

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Authors: Evangelia Kotrotsiou, Mairy Gouva, Theodosios Paralikas, Maria Fiaka, Styliani Kotrotsiou, Maria Malliarou

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The purpose of this research is to investigate the way nurses perceive the care provided in comparison to the way patients perceive it, taking into account existing literature. As far as the sample of research is concerned, it has come from the population of nurses working in the General Hospital of Thessaloniki, St. Paul and the patients of its surgical clinic. In the present study, the sample consists of 100 nurses and 88 patients. The questionnaire used was the Caring Nurse-Patient Interactions Scale: 23-Item Version, created by Cossette et al. (2006). In the case of both patients and nurses, a high score was observed in relational care in the case of the frequency of nursing care in daily practice, as well as the satisfaction of providing nursing care. Overall, patients rated higher clinical care in the case of the frequency of nursing care in daily practice, as well as the satisfaction of the clinical care they were given. On the other hand, nurses rated higher comfort care in the case of the frequency of nursing care in everyday practice, as well as relational care in the area of the importance of nursing care in everyday practice.

Keywords: nursing care, patient needs, patient satisfaction, care giving

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Authors: Li-Ting Huang, Yu-Hsiang Shen, Cing-Ciao Ke, Sheng-Pin Tseng, Fan-Pin Tseng, Yu-Ching Ni, Chia-Yu Lin

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Chest radiography is the most common technique for the diagnosis and follow-up of pulmonary diseases. However, the lesions superimposed with normal structures are difficult to be detected in chest radiography. Chest tomosynthesis is a relatively new technique to obtain 3D section images from a set of low-dose projections acquired over a limited angular range. However, there are some limitations with chest tomosynthesis. Patients undergoing tomosynthesis have to be able to hold their breath firmly for 10 seconds. A digital tomosynthesis system with advanced reconstruction algorithm and high-stability motion mechanism was developed by our research group. The potential for the system to perform a bidirectional chest scan within 10 seconds is expected. The purpose of this study is to realize the influences of the scan speed on the image quality for our digital tomosynthesis system. The major factors that lead image blurring are the motion of the X-ray source and the patient. For the fore one, an experiment of imaging a chest phantom with three different scan speeds, which are 6 cm/s, 8 cm/s, and 15 cm/s, was proceeded to understand the scan speed influences on the image quality. For the rear factor, a normal SD (Sprague-Dawley) rat was imaged with it alive and sacrificed to assess the impact on the image quality due to breath motion. In both experiments, the profile of the ROIs (region of interest) and the CNRs (contrast-to-noise ratio) of the ROIs to the normal tissue of the reconstructed images was examined to realize the degradations of the qualities of the images. The preliminary results show that no obvious degradation of the image quality was observed with increasing scan speed, possibly due to the advanced designs for the hardware and software of the system. It implies that higher speed (15 cm/s) than that of the commercialized tomosynthesis system (12 cm/s) for the proposed system is achieved, and therefore a complete chest scan within 10 seconds is expected.

Keywords: chest radiography, digital tomosynthesis, image quality, scan speed

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Authors: Bih-O Lee, Hsiu-Wan Hsieh, Hsiu-Chen Liu, Mer Yu Pan

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Background: Illness perceptions are developed when people face health-threatening situations. Previous research suggests that understanding discrepancies between illness perceptions of patients and caregivers may need to improve quality of health care. Objective: This study examined the differences between illness perceptions of injured patients and those of their caregivers. Methods: Comparative study design was used. The study setting was the surgical wards of a teaching hospital in Taiwan. Participants were 127 pairs of injured patients and their caregivers. The participants completed socio-demographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which comprises eight subscales. Clinical data of the injured patients was obtained from medical records. Results: This study found that injured patients were more pessimistic than their caregivers about the injury. There were significant differences between patients and caregivers insofar as patients perceived more physical symptoms, scored higher in terms of reasons for their injury, had more negative emotions and experienced more consequences than caregivers. Elderly caregivers and caregivers for patients who were over 65, severely injured and admitted to an ICU perceived more negative perceptions about the injury. Conclusions: This study indicated that patients and caregivers had negative illness representations several months after injury although the intensity of their perceptions was different. The interventions should highlight the need to assist patients and caregivers after injury.

Keywords: illness representations, injury, caregivers, comparative study

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Authors: Ifigeneia V. Mavragani, Zacharenia Nikitaki, George Kalantzis, George Iliakis, Alexandros G. Georgakilas

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Complex DNA damage consisting of a combination of DNA lesions, such as Double Strand Breaks (DSBs) and non-DSB base lesions occurring in a small volume is considered as one of the most important biological endpoints regarding ionizing radiation (IR) exposure. Strong theoretical (Monte Carlo simulations) and experimental evidence suggests an increment of the complexity of DNA damage and therefore repair resistance with increasing linear energy transfer (LET). Experimental detection of complex (clustered) DNA damage is often associated with technical deficiencies limiting its measurement, especially in cellular or tissue systems. Our groups have recently made significant improvements towards the identification of key parameters relating to the efficient detection of complex DSBs and non-DSBs in human cellular systems exposed to IR of varying quality (γ-, X-rays 0.3-1 keV/μm, α-particles 116 keV/μm and 36Ar ions 270 keV/μm). The induction and processing of DSB and non-DSB-oxidative clusters were measured using adaptations of immunofluorescence (γH2AX or 53PB1 foci staining as DSB probes and human repair enzymes OGG1 or APE1 as probes for oxidized purines and abasic sites respectively). In the current study, Relative Biological Effectiveness (RBE) values for DSB and non-DSB induction have been measured in different human normal (FEP18-11-T1) and cancerous cell lines (MCF7, HepG2, A549, MO59K/J). The experimental results are compared to simulation data obtained using a validated microdosimetric fast Monte Carlo DNA Damage Simulation code (MCDS). Moreover, this simulation approach is implemented in two realistic clinical cases, i.e. prostate cancer treatment using X-rays generated by a linear accelerator and a pediatric osteosarcoma case using a 200.6 MeV proton pencil beam. RBE values for complex DNA damage induction are calculated for the tumor areas. These results reveal a disparity between theory and experiment and underline the necessity for implementing highly precise and more efficient experimental and simulation approaches.

Keywords: complex DNA damage, DNA damage simulation, protons, radiotherapy

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