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PET-based tumor delineation is an error prone and labor intensive part of image analysis. Especially for patients with advanced disease showing bulky tumor FDG load, segmentations are challenging. Reducing the amount of user-interaction in the segmentation might help to facilitate segmentation tasks especially when labeling bulky and complex tumors. Therefore, this study reports on segmentation workflows/strategies that may reduce the inter-observer variability for large tumors with complex shapes with different levels of user-interaction. Twenty PET images of bulky tumors were delineated independently by six observers using four strategies: (I) manual, (II) interactive threshold-based, (III) interactive threshold-based segmentation with the additional presentation of the PET-gradient image and (IV) the selection of the most reasonable result out of four established semi-automatic segmentation algorithms (Select-the-best approach). The segmentations were compared using Jaccard coefficients (JC) and percentage volume differences. To obtain a reference standard, a majority vote (MV) segmentation was calculated including all segmentations of experienced observers. Performed and MV segmentations were compared regarding positive predictive value (PPV), sensitivity (SE), and percentage volume differences. The results show that with decreasing user-interaction the inter-observer variability decreases. JC values and percentage volume differences of Select-the-best and a workflow including gradient information were significantly better than the measurements of the other segmentation strategies (p-value<0.01). Interactive threshold-based and manual segmentations also result in significant lower and more variable PPV/SE values when compared with the MV segmentation. FDG PET segmentations of bulky tumors using strategies with lower user-interaction showed less inter-observer variability. None of the methods led to good results in all cases, but use of either the gradient or the Select-the-best workflow did outperform the other strategies tested and may be a good candidate for fast and reliable labeling of bulky and heterogeneous tumors.

Sarcomas are commonly managed by surgical resection combined with radiotherapy. Sarcoma treatment is frequently complicated by chronic wounds and late radiation tissue injury (LRTI). This study aims to gain insight in the use and results of hyperbaric oxygen therapy (HBOT) for radiation-induced complications following sarcoma treatment. All sarcoma patients treated between 2006 and 2017 in one of the five centers of the Institute for Hyperbaric Oxygen in the Netherlands were included for retrospective analysis. Thirty patients were included, 18 (60.0%) patients were treated for chronic wounds and 12 (40.0%) for LRTI. Two patients with chronic wounds were excluded from analysis as HBOT was discontinued within five sessions. In 11 of 16 (68.8%) patients treated for chronic wounds, improved wound healing was seen. Nine of 12 (75.0%) patients treated for LRTI reported a decline in pain. Reduction of fibrosis was seen in five of eight patients (62.5%) treated for LRTI. HBOT is safe and beneficial for treating chronic wounds and LRTI in the sarcoma population. Awaiting further prospective results, we recommend referring to HBOT centers more actively in patients experiencing impaired wound healing or symptoms of delayed radiation-induced tissue injury following multimodality sarcoma treatment.

Many of Canada's Aboriginal peoples have adopted the language, concepts and procedures of environmental resource management in order to advance their needs, rights and interests in co-management. Drawing on the author's experiences in co-management, the advantages and disadvantages of this project for Canada, its Aboriginal peoples, and its landscapes are explored. Alternatives to the status quo, grounded in social, cultural and ecological sustainability, and modelled after the tworow wampum, are then considered. Both Aboriginal and non-Aboriginal parties to co-management must critically examine current management policies and practices in order to develop innovative approaches that will create the space required for the meaningful and equitable inclusion of Aboriginal peoples in decisions taken in respect to their lands and resources.

This feasibility study aims to explore the use of three-dimensional virtual surgical planning to preoperatively determine the need for reconstructive surgery following resection of an extremity soft-tissue sarcoma. As flap reconstruction is performed more often in advanced disease, we hypothesized that tumor volume would be larger in the group of patients that had undergone flap reconstruction. All patients that were treated by surgical resection for an extremity soft-tissue sarcoma between 1 January 2016 and 1 October 2019 in the University Medical Center Groningen were included retrospectively. Three-dimensional models were created using the diagnostic magnetic resonance scan. Tumor volume was calculated for all patients. Three-dimensional tumor volume was 107.8 (349.1) mL in the group of patients that had undergone primary closure and 29.4 (47.4) mL in the group of patients in which a flap reconstruction was performed, p = 0.004. Three-dimensional tumor volume was 76.1 (295.3) mL in the group of patients with a complication following ESTS treatment, versus 57.0 (132.4) mL in patients with an uncomplicated course following ESTS treatment, p = 0.311. Patients who had undergone flap reconstruction had smaller tumor volumes compared to those in the group of patients treated by primary closure. Furthermore, a larger tumor volume did not result in complications for patients undergoing ESTS treatment. Therefore, tumor volume does not seem to influence the need for reconstruction. Despite the capability of three-dimensional virtual surgical planning to measure tumor volume, we do not recommend its utilization in the multidisciplinary extremity soft-tissue sarcoma treatment, considering the findings of the study.

BackgroundThis study explores various volume of interest (VOI) delineation techniques for fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) scans during neoadjuvant extremity soft tissue sarcoma (ESTS) treatment.ResultsDuring neoadjuvant treatment, hyperthermic isolated limb perfusion (HILP) and preoperative external beam radiotherapy (EBRT), 11 patients underwent three 18F-FDG PET-CT scans. The first scan was made prior to the HILP, the second after the HILP but prior to the start of the EBRT, and the third prior to surgical resection. An automatically drawn VOIauto, a manually drawn VOIman, and two gradient-based semi-automatically drawn VOIs (VOIgrad and VOIgrad+) were obtained. Maximum standardized uptake value (SUVmax), SUVpeak, SUVmean, metabolically active tumor volume (MATV), and total lesion glycolysis (TLG) were calculated from each VOI. The correlation and level of agreement between VOI delineation techniques was explored. Lastly, the changes in metabolic tumor activity were related to the histopathologic response. The strongest correlation and an acceptable level of agreement was found between the VOIman and the VOIgrad+ delineation techniques. A decline (VOIman) in SUVmax, SUVpeak, SUVmean, TLG, and MATV (all p < 0.05) was found between the three scans. A > 75% decline in TLG between scan 1 and scan 3 possibly identifies histopathologic response.ConclusionsThe VOIgrad+ delineation technique was identified as most reliable considering reproducibility when compared with the other VOI delineation techniques during the multimodality neoadjuvant treatment of locally advanced ESTS. A significant decline in metabolic tumor activity during the treatment was found. TLG deserves further exploration as predictor for histopathologic response after multimodality ESTS treatment.

Increasingly, federal environmental guidelines require developers to consider the \"traditional knowledge\" of aboriginal people in assessing the impact of proposed projects on northern environments, economies, and societies. However, several factors have limited the contributions of traditional knowledge to environmental impact assessment (EIA) in the North, including confusion over the meaning of this term, who \"owns\" this knowledge, and its role in EIA. The term \"indigenous knowledge,\" which comprises traditional and nontraditional, ecological and nonecological knowledge, is proposed as an alternative that should allow aboriginal people, and the full scope of their knowledge, to assume integral roles in EIA. Experience gained in attempting to give aboriginal people a voice and an assessment role in the diamond mine proposed by Diamonds Inc. at Lac de Gras in the Northwest Territories has led to the development of a multiphased, holistic approach to involving aboriginal people and their knowledge in EIA. Because of their in-depth knowledge of the land, aboriginal people have a particularly important role to play in environmental monitoring and distinguishing project-related changes from natural changes in the environment. However, the strengths of traditional and Western scientific knowledge in EIA will not be realized until both are recognized as parts of a larger worldview that influences how people perceive and define reality. /// De plus en plus, les lignes directrices environnementales du gouvernement fédéral exigent des responsables de projets de développement qu'ils tiennent compte du «savoir traditionnel» des peuples autochtones en évaluant les incidences des projets à l'étude sur les milieux, les économies et les sociétés nordiques. Toutefois, plusieurs facteurs ont limité la contribution du savoir traditionnel à l'évaluation des incidences environnementales (EIE) dans le Grand Nord, y compris l'ambiguïté entourant le sens de cette expression, la personne qui «détient» ce savoir, et son rôle dans l'EIE. On propose l'emploi de l'expression «savoir autochtone» , qui englobe savoir traditionnel et non traditionnel, savoir écologique et non écologique, comme une solution qui permettrait aux peuples autochtones, ainsi qu'à toute la dimension de leur savoir, d'assumer un rôle intégral dans EIE. L'expérience acquise lors des efforts en vue de donner une voix et un rôle d'évaluateurs aux autochtones dans le projet d'exploitation de la mine diamantifère de Diamonds Inc. à Lac de Gras (Territoires du Nord-Ouest) a conduit à une approche holistique, à facettes multiples, qui vise à faire participer les autochtones et leur savoir à l'EIE. En raison de leur connaissance approfondie de la terre, les autochtones ont un rôle particulièrement important à jouer dans lé contrôle de l'environnement et la distinction entre les changements environnementaux dus aux projets et ceux dus à la nature. Toute la force du savoir traditionnel et des connaissances scientifiques occidentales ne se manifestera toutefois que lorsqu'on admettra que les deux parties participent à une vision du monde élargie qui influence la façon dont les individus définissent la réalité.

Two complementary models illuminate the formation of artifact assemblages at one type of prehistoric hunter-gatherer campsite—the workshop/habitation site. One model posits three successive stages in the activity contributing to the distribution and composition of lithic artifact assemblages. The other describes the formation of assemblages near exterior hearths and similar features. These models are discussed with reference to the Peace Point site, a rapidly buried and deeply stratified workshop/habitation site in northern Alberta. The implications of these models for refining our understanding of formation processes at other types of hunter-gatherer campsites are noted.

The search for structure in Central Inuit socioeconomic organization has been a frustrating quest for Arctic anthropologists. The inability to explain variability within and between regional groups has led to post hoc accommodative arguments which hold that Central Inuit society is somehow less structured than other preliterate societies, or that the environment is the ultimate architect of their socioeconomy. This thesis, in exploring the structural basis of variability in Central Inuit socioeconomic organization, directly challenges both assumptions. After reviewing existing models and theories of Inuit social organization, a search for structural coherence in Central Inuit socioeconomic organization is initiated. This search begins in Cumberland Sound, Baffin Island, Northwest Territories. A new interpretation of the late prehistory of the Sound is offered, after which a history of Inuit-white relations between 1840 and 1970 is provided. Despite the fact that few other Central Inuit groups experienced as long or as intense an association with Euroamerican culture as the Cumberland Sound Inuit, it is argued that the latter did not undergo a significant transformation in social structure as a consequence of contact with commercial whalers, missionaries, traders, and foreign diseases. Subsequently, relying on informant recall and archival sources, an analysis of local group composition between 1920 and 1970 in Cumberland Sound is undertaken. Differences between the two major subregional groups to have occupied the Sound during the contact-traditional period, the Kekertormiut and Umanaqjuarmiut, are seen to be manifestations of two structural tendencies inherent within Central Inuit social relationships. Whereas the former were governed largely by hierarchical directives (naalaqtuq), productive relationships among the latter were constituted more on egalitarian behaviours (ungayuq). This model permitted a detailed re-analysis of the late prehistory of the Sound. However, just as importantly, it allowed a closer examination of structural variability in Iglulingmiut, Netsilingmiut, and Copper Inuit socioeconomic organization. While the former two regional populations are found to be embellishments, respectively, of naalaqtuq and ungayuq, the Copper Inuit are seen to be a rejection of Central Inuit social structure and ideology. The archaeological and anthropological implications of this theory as well as other perspectives advanced throughout the thesis are then explored. In so doing, alternative models of Canadian Arctic prehistory and the origins of \"complex\" social structures, such as those exemplified by the Central Inuit and Euroamerican society, are advanced.