Explore the vast range of titles available.

Purpose There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. Methods This study is a narrative non-systematic review. Results We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. Conclusion Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.

Purpose There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. Methods Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. Results PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength , typically between 633 and 685 nm or 780–830 nm; energy density , laser or light-emitting diode (LED) output between 10 and 150 mW; dose , 2–3 J (J/cm 2 ), and no more than 6 J/cm 2 on the tissue surface treated; treatment schedule , two to three times a week up to daily; emission type , pulsed (<100 Hz); and route of delivery , intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. Conclusion PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.

Aims: To examine the course and the predictors of the persistence of cannabis dependence. Methods: Through cannabis outlets and chain referral, a prospective enriched community cohort of 207 young adults (aged 18-30) with DSM-IV cannabis dependence at baseline (T0) was formed and followed-up after 1.5 (T1) and 3 (T2) years. The presence of cannabis dependence, cannabis-related problems, functional impairment and treatment was assessed using the Composite International Diagnostic Interview (CIDI 3.0) and the Sheehan Disability Scale (SDS). Predictors of persistence were lifetime cannabis abuse and dependence symptoms, cannabis use characteristics, distant vulnerability factors (e.g. childhood adversity, family history of psychological/substance use problems, impulsivity, mental disorders), and proximal stress factors (recent life events, social support). Results: Four groups were distinguished: persistent dependent (DDD: 28.0%), stable non-persistent (DNN: 40.6%), late non-persistent (DDN: 17.9%) and recurrent dependent (DND: 13.5%). At T2, persisters (DDD) reported significantly more (heavy) cannabis use and cannabis problems than non-persisters (DNN/DDN/DND). Treatment seeking for cannabis-related problems was rare, even among persisters (15.5%). The number (OR = 1.23 (1.03-1.48)) and type (‘role impairment' OR = 2.85 (1.11-7.31), ‘use despite problems' OR = 2.34 (1.15-4.76)) of lifetime cannabis abuse/dependence symptoms were the only independent predictors of persistence with a total explained variance of 8.8%. Conclusions: Persistence of cannabis dependence in the community is low, difficult to predict, and associated with a negative outcome. The substantial proportion of stable non-persisters suggests that screening and monitoring or low-threshold brief interventions may suffice for many non-treatment-seeking cannabis-dependent people. However, those with many lifetime abuse/dependence symptoms may benefit from more intensive interventions.

In a 3-year qualitative longitudinal study the role of social relationships in cannabis use and dependence in young adults (all frequent users at baseline) was explored. Overall, cannabis use and dependence declined. Changes in use were, for a considerable part, attributable to processes and life events in social relationships with peers and partners, while parents had little influence. Negatively experienced events often triggered increased use and positively experienced events decreased use. Participants often adapted their use to others, depending on associate's use. Underlying mechanisms appear related to both socialization and selection. Gender-specific processes occurred, particularly with regard to partners; females selected using partners and males nonusing partners, and subsequently cannabis use increased (females) or decreased (males) by socialization. Transitions in cannabis dependence could be explained by using peers, cohabitation and, for females, a new partnership. Persistent and newly nondependent participants were less susceptible to social influences than dependent interviewees.

The concept of sustainability has grown in recognition and importance. The pressure on companies to broaden their reporting and accountability from economic performance for shareholders, to sustainability performance for all stakeholders is leading to a change of mindset in consumer behaviour and corporate policies. How can we develop prosperity without compromising the life and needs of future generations? Sustainability in Project Management explores and identifies the questions surrounding the integration of the concepts of sustainability in projects and project management and provides valuable guidance and insights. Sustainability relates to multiple perspectives, economical, environmental and social, but also to responsibility and accountability and values in terms of ethics, fairness and equality. The authors will inspire project managers to be aware of these considerations, and to apply them to the role they play in projects, not just 'doing things right' but 'doing the right things right'. Contents: Foreword, Nelmara Arbex; Foreword, Miles Shepherd; Preface; Introduction, Gilbert Silvius, Ron Schipper and Adri Köhler; Sustainability in business, Julia Planko and Gilbert Silvius; Sustainability and projects, Gilbert Silvius and Ron Schipper; Incorporating sustainability in project management, Gilbert Silvius, Ron Schipper and Jasper van den Brink; Reflection and conclusion, Gilbert Silvius, Ron Schipper and Jasper van den Brink; Getting started, Ron Schipper and Gilbert Silvius; Appendices; Further reading; Index. Gilbert Silvius is professor at HU University of Applied Sciences Utrecht in the Netherlands and principal consultant at Van Aetsveld, project and change management. He is founder and program director of the Master of Project Management program at HU and an active member of IPMA, PMI and the ISO TC258. Ron Schipperr is project manager and consultant at Van Aetsveld, project and change management. He has over 15 years of experience as a project manager in realizing change in various organizations. Next to executing projects, he is interested in developing the profession of project managers and transferring this knowledge to others. Julia Planko works as researcher and lecturer at HU University of Applied Sciences Utrecht since 2008. She lectures in Economics and Marketing and supervises students with sustainability related research projects. Julia studied International Business Management and International Economics and worked as associate lecturer at the Berlin School of Economics. . Jasper van den Brink is an experienced project and program manager. He joined HU University of Applied Sciences Utrecht in 2008. Jasper specializes in training project management skills and the behavioral competences of (project) management. His research includes the application of modern psychological insights in project management. Adri Köhler is a senior consultant and project leader in the field of ICT and business operations. He was the project leader of the development of the Master of Project Management at HU and was course director of this program.

In a Dutch longitudinal study on the dynamics of cannabis dependence, at baseline 600 frequent cannabis users (? 3 days cannabis use per week in past 12 months) aged 18–30 years were interviewed. Nearly half of all participants (42%) met DSM-IV criteria for cannabis dependence in the 12 months prior to the interview. Participants were recruited by respondent-driven sampling; referrals were understood as proxy for social networks to explore peer associations and social exclusion. Analyses revealed that networks of frequent cannabis users were mostly heterogeneous. Cannabis dependence did not emerge as a main selector. However, within segments of networks some clustering of cannabis dependence (indicating differential inclusion), sex and ethnicity was found. Methodological questions are discussed regarding the applicability of respondent-driven sampling in noninjecting, nonmarginalized drug users. The study's limitations are noted.