TY - JOUR. T1 - Patterns of relapse following radiotherapy for differentiated thyroid cancer. T2 - Implication for target volume delineation. AU - Azrif, Muhammad. AU - Slevin, Nicholas J.. AU - Sykes, Andrew J.. AU - Swindell, Ric. AU - Yap, Beng K.. PY - 2008/10. Y1 - 2008/10. N2 - Introduction: Post-operative residual disease in differentiated thyroid cancer is an indication for external beam radiotherapy (EBRT) especially if there is poor radioiodine uptake by the residual disease. There are no standardized guidelines or consensus in target delineation for radiotherapy in thyroid cancer. Aims: To determine the pattern of recurrence in patients with well differentiated thyroid cancer who received adjuvant or definitive radiotherapy as well as radioiodine ablation following surgery or biopsy with a view to better defining future target volume delineation for radiotherapy. Materials and methods: Forty-nine patients with differentiated thyroid cancer received radical external beam radiotherapy ...
The global move towards more conformal radiotherapy for rectal cancer requires better imaging modalities that both visualise the disease accurately and are reproducible; to reduce interobserver variation. This review explores the advances in imaging modalities used in target volume delineation, with a view to make recommendations for current clinical practice and to propose future directions for research. A systematic review was conducted using MEDLINE and EMBASE. Articles considered relevant by the authors were included. Planning with orthogonal films is being replaced by computed tomography (CT) simulation. This is now considered the gold standard and allows conformal three-dimensional planning. Magnetic resonance imaging (MRI) has been shown to overcome some of the limitations of CT and can be used either as a diagnostic image to visually aid planning, or as a planning MRI carried out in the treatment position and co-registered with the planning CT. The latter approach has been shown to ...
|p||i||b|Radiation Therapy Treatment Effects|/b||/i| is a practical guide to common and uncommon toxicities which occur related to radiation therapy. Organized by anatomic region, from CNS to skin and extremities, this handbook concisely and comprehensive
TY - JOUR. T1 - WE‐G‐BRCD‐01. T2 - A Procedure for Efficient Large‐Scale Retrospective Clinical Studies for Online Adaptive Radiotherapy. AU - Lambrecht, M.. AU - Graves, Y.. AU - Gautier, Q.. AU - Tian, Z.. AU - Kim, G.. AU - Uribe‐sanchez, A.. AU - Jia, X.. AU - Jiang, S.. PY - 2012. Y1 - 2012. N2 - Purpose: Online adaptive radiotherapy (ART) is promising for handling inter‐fraction variations of patients geometry. Before a clinical implementation of this advanced technology, it is necessary to study its potential clinical gains and optimal frequencies to be used for various tumor sites. The goal of this work is to establish and examine a procedure for efficient large‐scale retrospective clinical studies for online ART using a GPU‐based re‐planning platform. Methods: The proposed procedure utilizes an in‐house developed GPU‐based replanning software called SCORE. SCORE starts by applying deformable registration from CT to CBCT and correcting CBCT artifacts and ...
Photon Beam Dose Calculation Algorithms. Kent A. Gifford, Ph.D. Medical Physics III Spring 2010. Dose Computation Algorithms. Correction-based (Ancient!) Convolution (Pinnacle,Eclipse,…) Monte Carlo (Stochastic) Deterministic (Non-stochastic). Photon Source. Standard SSD. Patient...
PURPOSE Accurate delineation of target volume and normal tissue is critical for intensity modulated radiation therapy (IMRT) use in cervical cancer. Phase III Multicentre Trial of Weekly Induction Chemotherapy Followed by Standard Chemoradiation versus Standard Chemoradiation Alone in Patients With Locally Advanced Cervical Cancer (INTERLACE) radiation therapy quality assurance (RTQA) has highlighted significant interobserver delineation variation. Prescriptive guidelines reduce interobserver variation in other cancers. METHODS AND MATERIALS A literature search using PubMed/Medline database of guidelines for target anatomy delineation in cervical cancer was undertaken. Differences in practice in these publications and INTERLACE trial RTQA were identified. Consensus best practice delineation was derived and a pictorial atlas produced. The proportion of outlines complying with protocol in test and real-time cases was compared before and after atlas implementation within the INTERLACE RTQA pack.
In the current study, we assessed the conventional BRT plan based on ICRU reference points and the CT-based BRT plan in patients with cervical cancer. We clearly demonstrated that tumor volume coverage was inadequate in the conventional plan compared to the CT-plan, and was inversely related with the volume of the target and the extension of tumor. With the conventional plan, the ICRU rectum and bladder point doses underestimated the actual rectum and bladder doses obtained from the CT-plan. Additionally, we demonstrated that more precise analysis of the dose received by certain volume of OARs can be accomplished by utilizing the DVHs on CT-plans, which may be of critical importance in regard to normal tissue tolerance limits.. After publication of ICRU 38 report, ICRU reference points for tumors, and reference dose points for bladder and rectum were used for defining the doses in conventional plans. But calculation of doses with these fixed reference points relative to applicators has certain ...
The Helical Tomotherapy treatment planning system uses a relatively accurate collapsed cone convolution/superposition algorithm for dose calculation and, as with other non -Monte Carlo algorithms, charged particle equilibrium is assumed in the dose calculation. For this reason we can expect inaccuracy in predicting dose distribution in the presence of significant inhomogeneities in patient geometry where this assumption is not satisfied. The dose distribution accuracy of the HT TPS was then tested in case of low density lung lesions.. Before the validation of the dose calculation algorithm in inhomogeneous media, the agreement between measured and calculated dose distributions for lung treatments was verified in a homogeneous phantom. Excellent agreement was found for point dose measurements with most of the data within ± 2%; an average percentage discrepancy equal to 0.85% (1SD = 0.5%) was estimated by considering all the points, both in PTV and in OAR regions. Good agreement (3%- 3 mm ...
Purpose: Dose volume histograms (DVHs) are common tools in radiation therapy treatment planning to characterize plan quality. As statistical metrics, DVHs provide a compact summary of the underlying plan at the cost of losing spatial information: the same or similar dose-volume histograms can arise from substantially different spatial dose maps. This is exactly the reason why physicians and physicists scrutinize dose maps even after they satisfy all DVH endpoints numerically. However, up to this point, little has been done to control spatial phenomena, such as the spatial distribution of hot spots, which has significant clinical implications. To this end, the authors propose a novel objective function that enables a more direct tradeoff between target coverage, organ-sparing, and planning target volume (PTV) homogeneity, and presents our findings from four prostate cases, a pancreas case, and a head-and-neck case to illustrate the advantages and general applicability of our method.Methods: In ...
During external beam radiation therapy, a beam (or multiple beams) of radiation is directed through the skin to the cancer and the immediate surrounding area to destroy the tumor and any nearby cancer cells.
SRS/SBRT/SABR is generally best for very small tumors. Doctors use specialized scans to pinpoint exactly where the tumor target is located. A customized holder may be used to keep the body perfectly still during treatment. Some treatment machines have the ability to adjust for patient motion such as during breathing.. These techniques allow doctors to give a high dose of radiation to the tumor in a short amount of time. SRS/SBRT/SABR is a type of external beam radiation therapy that can be completed in one to five treatments.. The advantage of SRS/SBRT/SABR is it delivers the right amount of radiation to the cancer in a shorter amount of time than traditional treatments. Plus the treatment is delivered with extreme accuracy, minimizing the effect on other nearby organs.. A disadvantage of SRS/SBRT/SABR is that this technique is suitable only for small, well-defined tumors that can be seen on imaging such as CT or MR scans, thus this approach is not suitable for all situations. Also, the amount ...
Radiotherap-e is a web-based e-learning resource produced in partnership with The Royal College of Radiologists, the Institute of Physics and Engineering in Medicine, the Society and College of Radiographers, and Health Education England e-Learning for Healthcare.. Radiotherap-e offers multi-professional learning resources for the trained workforce involved in the delivery of radiotherapy, including clinical oncologists, physicists, radiographers and dosimetrists.. The aim is to provide the knowledge base and practical skills training to support the implementation of advanced radiotherapy techniques in the UK.. Topics covered include image interpretation and target volume delineation, dosimetry planning and optimisation, quality assurance and patient care.. The sessions include a variety of media including text, images, animations, videos and assessments, as well as a number of customised tools which simulate everyday tasks in the radiotherapy process.. ...
PURPOSE AND OBJECTIVES: We report on the clinical outcomes of a phase 2 study assessing image guided hypofractionated weekly radiation therapy in bladder cancer patients unsuitable for radical treatment. METHODS AND MATERIALS: Fifty-five patients with T2-T4aNx-2M0-1 bladder cancer not suitable for cystectomy or daily radiation therapy treatment were recruited. A "plan of the day" radiation therapy approach was used, treating the whole (empty) bladder to 36 Gy in 6 weekly fractions. Acute toxicity was assessed weekly during radiation therapy, at 6 and 12 weeks using the Common Terminology Criteria for Adverse Events version 3.0. Late toxicity was assessed at 6 months and 12 months using Radiation Therapy Oncology Group grading. Cystoscopy was used to assess local control at 3 months. Cumulative incidence function was used to determine local progression at 1 at 2 years. Death without local progression was treated as a competing risk. Overall survival was estimated using the Kaplan-Meier method. ...
Methods: The following process was used to generate a 3D intensity-modulated grid-therapy plan. First, based on the geometry of the target volume and organs at risk (OAR), three to six radiation fields were selected to minimize the overlap between the target volume and OARs. Typically, three orthogonal fields were used to minimize the overlap between the fields to maintain grid-like dose distribution for each field. Second, a step-and-shoot IMRT plan was generated with selected fields using Pinnacle treatment planning system (Philips Medical Systems). Third, each MLC segment was converted to a grid field defined by additional MLC segments using an in-house developed program. Finally, the plan was further optimized using segment weight optimization in Pinnacle treatment planning system, maintaining the grid shape for each IMRT field with optimized intensities for the opening grids. The method was tested for a few clinical cases with bulky tumors. Dose distributions and dose volume histograms were ...
Focal therapy for prostate cancer has been proposed as an alternative treatment to whole gland therapy, offering the opportunity for tumor dose escalation and/or reduced toxicity. Brachytherapy, either low-dose-rate or high-dose-rate, provides an ideal approach, offering both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines on target volume delineation, treatment planning margins, treatment planning approaches, and many other technical issues that should be considered before implementing a focal brachytherapy program ...
Purpose: This work aims to facilitate a fast magnetic resonance (MR)-only workflow for radiation therapy of intracranial tumors. Here, we evaluate whether synthetic computed tomography (sCT) images generated with a dilated convolutional neural network (CNN) enable accurate MR-based dose calculations in the brain. Methods and Materials: We conducted a retrospective study of 52 patients with brain tumors who underwent both computed tomography (CT) and MR imaging for radiation therapy treatment planning. To generate the sCTs, a T1-weighted gradient echo MR sequence was selected from the clinical protocol for multiple types of brain tumors. sCTs were created for all 52 patients with a dilated CNN using 2-fold cross validation; in each fold, 26 patients were used for training and the remaining 26 patients were used for evaluation. For each patient, the clinical CT-based treatment plan was recalculated on sCT. We calculated dose differences and gamma pass rates between CT- and sCT-based plans inside ...
Healthcare Sales & Marketing Network: New Data Reinforce Benefits of TomoTherapy(R) Platform for Mainstream Radiation Therapy Treatment Indications
A spinal implant with associated surgical tools, tool sets and methods for percutaneously accessing and preparing treatment sites within the spine for subsequent treatment procedures. The treatment site may be an inter-vertebral motion segments in the lumbar and sacral regions of the spine. The tool set may comprise introducer tools and bone dilators for accessing and tapping into a targeted site, such as, for example, the anterior surface of the S1 vertebral body. The tool set may also comprise cutters and extractors for preparing the treatment site for subsequent treatment procedures. The tool set may additionally comprise a bone graft inserter, an exchange system, and/or a temporary distraction tool for further preparing the treatment site for subsequent treatment procedures.
Disclosed are surgical tools, tool sets and methods for percutaneously accessing and preparing treatment sites within the spine for subsequent treatment procedures. The treatment site may be an inter-vertebral motion segments in the lumbar and sacral regions of the spine. The tool set may comprise introducer tools and bone dilators for accessing and tapping into a targeted site, such as, for example, the anterior surface of the S1 vertebral body. The tool set may also comprise cutters and extractors for preparing the treatment site for subsequent treatment procedures. The tool set may additionally comprise a bone graft inserter, an exchange system, and/or a temporary distraction tool for further preparing the treatment site for subsequent treatment procedures.
A study of real-time adaptive radiotherapy systems was performed to test the hypothesis that, across delivery systems and institutions, the dosimetric accuracy is improved with adaptive treatments over non-adaptive radiotherapy in the presence of patient-measured tumor motion.Ten institutions with robotic(2), gimbaled(2), MLC(4) or couch tracking(2) used common materials including CT and structure sets, motion traces and planning protocols to create a lung and a prostate plan. For each motion trace, the plan was delivered twice to a moving dosimeter; with and without real-time adaptation. Each measurement was compared to a static measurement and the percentage of failed points for γ-tests recorded.For all lung traces all measurement sets show improved dose accuracy with a mean 2%/2mm γ-fail rate of 1.6% with adaptation and 15.2% without adaptation (p,0.001). For all prostate the mean 2%/2mm γ-fail rate was 1.4% with adaptation and 17.3% without adaptation (p,0.001). The difference between the ...
Purpose/Objective(s): To evaluate the effects of various patient characteristics and radiation therapy treatment variables on outcomes in advanced-stage retinoblastoma. Methods and Materials: This was a retrospective review of 41 eyes of 30 patients treated with external beam radiation therapy between June 1, 1992, and March 31, 2012, with a median follow-up time of 133 months (11 years). Outcome measures included overall survival, progression-free survival, local control, eye preservation rate, and toxicity. Results: Over 90% of the eyes were stage V. Definitive external beam radiation therapy (EBRT) was delivered in 43.9% of eyes, adjuvant EBRT in 22% of eyes, and second-line/salvage EBRT in 34.1% of eyes. A relative lens sparing (RLS) technique was used in 68.3% of eyes and modified lens sparing (MLS) in 24.4% of eyes. Three eyes were treated with other techniques. Doses ≥45 Gy were used in 68.3% of eyes. Chemotherapy was a component of treatment in 53.7% of eyes. The 10-year overall ...
We presented a planning approach with physician navigation as a defining part of the process. While making planning more patient independent by creating standardized databases, our approach makes it more individualized for each patient by not following the same standard prescription for everyone but finding the best trade-offs for every individual. This study sought to determine if standardized MCO templates plus physician navigation of the resulting Pareto surfaces could offer a viable alternative to the standard planning process, where tradeoffs are explored by the treatment planners and the physicians are only involved in the final YES/NO decision.. Our retrospective planning study is subject to limitations given by inherent differences between clinical and physician driven planning. Although clinical plans were generated by different dosimetrists, they were regarded as comparable. Different qualities within plans may have resulted due to individual planning strategies and personal ...
Head and neck cancer refers collectively to cancers that arise in the head and neck region, including the nasal cavity, sinuses, mouth, lips, salivary glands, larynx or throat. These cancers typically begin in the squamous cells that line the moist surfaces inside the mouth, nose and throat. Radiation therapy is used to treat head and neck cancer painlessly and noninvasively. External beam radiation therapy (EBRT) is an effective treatment for head and neck cancer, working within cancer cells to damage their ability to multiply. During treatment, high-energy X-rays are delivered to the cancer cells with a linear accelerator (LINAC). Treatments are delivered daily Monday through Friday. Each treatment takes about 10 to 15 minutes. The treatment process is painless, safe and will not burn or hurt you. Side effects are usually minimal, and most patients return to routine activities immediately after each treatment. Several factors determine candidacy for radiation therapy treatment including the ...
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More and more advanced radiotherapy techniques have been adopted for post-mastectomy radiotherapies (PMRT). Patient dose reconstruction is challenging for these advanced techniques because they increase the low out-of-field dose area while the accuracy of out-of-field dose calculations by current commercial treatment planning systems (TPSs) is poor. We aim to measure and model the out-of-field radiation doses from various advanced PMRT techniques. PMRT treatment plans for an anthropomorphic phantom were generated, including volumetric modulated arc therapy (VMAT) with standard and flattening-filter-free (FFF) photon beams, mixed beam therapy, 4-field intensity modulated radiation therapy (IMRT), and Tomotherapy ...
H.R. 2104 Introduced June 6, 2011 - CARE Act Representative Ed Whitfield (R-KY) introduced the Consistency, Accuracy, Responsibility, and Excellence (CARE) in Medical Imaging and Radiation Therapy Act of 2011 in the House of Representatives (H.R. 2104). The CARE Act takes an important step in ensuring upmost safety for patients receiving potentially life-saving radiation therapy procedures by setting minimum certification and educational standards for non-physician technical personnel performing medical imaging and administering radiation therapy to patients. The CARE bill, which as of June 22nd already has 33 cosponsors in addition to its chief sponsor, Rep. Whitfield, would set federal minimum education and certification standards in the Medicare program for the technical personnel providing, planning and delivering all medical imaging examinations and radiation therapy treatments. Following the introduction of the bill, it was immediately referred to the House Energy and Commerce Committee ...
Are you sure your patient will not move during treatment? High conformance radiation therapy treatment modalities require precise patient positioning.
a) In General- Section 1877(b)(2) of the Social Security Act (42 U.S.C. 1395nn(b)(2)) is amended-- (1) in the matter before subparagraph (A), by striking `and supplies and inserting `, supplies, and certain advanced diagnostic imaging services; and (2) by adding at the end the following: `For purposes of this paragraph, the term `certain advanced diagnostic imaging services means diagnostic magnetic resonance imaging, computed tomography, and positron emission tomography, and such other diagnostic imaging services, including services described in section 1848(b)(4)(B) (but excluding X-ray, ultrasound, and fluoroscopy), as specified by the Secretary in consultation with physician specialty organizations and other stakeholders, but does not include imaging services performed for purposes of radiation therapy treatment planning or in conjunction with an interventional radiological procedure or nuclear medicine other than positron emission tomography.. (b) Effective Date- The amendments made by ...
The most frequent cause of neuropathic pain was the tumor itself, and cisplatin was the most frequently used chemotherapeutic agent. Fentanyl patches were used more frequently in the pregabalin group. Pain intensity improved in all patients at eight weeks, but improved more with pregabalin (change = 0, 9 points, p = 0.0084). Depression and anxiety decreased significantly in both groups. Physical component and mental component scores on the SF-12 improved in all patients, but improved more in those on pregabalin. When data were adjusted for age and sex, differences from baseline scores were less than 1. There were significant differences in groups in other medications used, numbers of analgesic interventions, and amount of radiation therapy treatment. ...
An electrode catheter is introduced into a hollow anatomical structure, such as a vein, and is positioned at a treatment site within the structure. Tumescent fluid is injected into the tissue surrounding the treatment site to produce tumescence of the surrounding tissue which then compresses the vein. The solution may include an anesthetic, and may further include a vasoconstrictive drug that shrinks blood vessels. The tumescent swelling in the surrounding tissue causes the hollow anatomical structure to become compressed, thereby exsanguinating the treatment site. Energy is applied by an electrode catheter in apposition with the vein wall to create a heating effect. The heating effect causes the hollow anatomical structure to become molded and durably assume the compressed dimensions caused by the tumescent technique. The electrode catheter can be moved within the structure so as to apply energy to a large section of the hollow anatomic structure. In a further aspect, the location of the electrodes is
TY - JOUR. T1 - Radiotherapy of lung cancers. T2 - FFF beams improve dose coverage at tumor periphery compromised by electronic disequilibrium. AU - Vassiliev, Oleg N.. AU - Kry, Stephen F.. AU - Wang, He C.. AU - Peterson, Christine B.. AU - Chang, Joe Y.. AU - Mohan, Radhe. PY - 2018/9/28. Y1 - 2018/9/28. N2 - The purpose of this work was to investigate radiotherapy underdosing at the periphery of lung tumors, and differences in dose for treatments delivered with flattening filter-free (FFF) beams and with conventional flattened (FF) beams. The true differences between these delivery approaches, as assessed with Monte Carlo simulations, were compared to the apparent differences seen with clinical treatment planning algorithms AAA and Acuros XB. Dose was calculated in a phantom comprised of a chest wall, lung parenchyma, and a spherical tumor (tested diameters: 1, 3, and 5 cm). Three lung densities were considered: 0.26, 0.2, and 0.1 g cm-3, representing normal lung, lung at full inspiration, ...
The investigators group uses an individualised radiation dose approach in which the dose is escalated up to pre-defined tissue constraints (see below).
Pareto distribution : d, p, q, r functions are implemented in VGAM for the Pareto distribution type IV (which includes Burrs distribution, Pareto type III, Pareto type II (also called the lomax distribution) and Pareto type I) and the (upper/lower) truncated Pareto distribution. In an actuarial context, actuar provides d, p, q, r functions as well as moments and limited expected values for the Pareto I and II, the inverse Pareto, the generalized pareto distributions, the Burr and the inverse Burr distributions, all special cases of the transformed beta II distribution. A fast random generator for the Burr and the Pareto II distribution is implemented in Runuran as well as the density. EnvStats provides d, p, q, r functions for Pareto I distribution. extremefit provides the Burr, the Pareto II, mixture of Pareto I distributions and a composite distribution of two Pareto I distributions. ExtDist provides the Burr distribution. lmomco, evd, fExtremes, extraDistr, QRM, Renext, revdbayes, FAdist ...
Dose distributions of the three treatment plans from the Blue water phantom study.(a) Plan without a bolus, (b) plan with the superflab bolus, and (c) plan with
A system and method for delivering and assembling a bifurcated stent in a bifurcated vessel having a first lumen and a second lumen. The system and method includes the use of three balloon catheters wherein at least one of the catheters is a fixed wire catheter. A first segment of the bifurcated stent having a stem portion, a first leg portion, a longitudinal bore extending therethrough and a branch aperture formed in the side wall is mounted on two of the balloon catheters and delivered to the treatment site where it is implanted into the first lumen. A second segment of the bifurcated stent having a proximal end, a distal end and a longitudinal bore extending therethrough is mounted on the third balloon catheter and is delivered to the treatment site such that the distal end extends into the second lumen and the proximal end extends into longitudinal bore of the first segment. The second segment is then implanted into the second lumen and secured to the branch aperture of the first segment to form a
Right when we think we have abolished acne from our face, it pops up on other areas of our body such as the back. Skincare-News.coms latest article, ... ...
ميز ارخص شركة نقل اثاث بالدمام كما ذكرنا بالاعلي باننا في المركز السعودي الخدمي بالدمام والخبر ونكون فى غاية السعادة عندما بخدمتكم دائما وفي المقابل نسعي للتميز حتي نكسب ثقتكم فالجميع يسعي دائما للتعاقد مع افضل وارخص شركة نقل اثاث بالدمام وهذا هو هدفنا ان نكون الافضل دائما من ناحية جودة الخدمات و الاسعار ايضا فاننا نقدم اليكم خدمات نقل جميع محتويات ...
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1. The probability of postradiation complications caused by the same total dose is lower in case of the uniform dose distribution. 2. If ω is close to .1, the irradiated tissue can be regarded as a...
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A 76-year-old man with prostate cancer has become the first radiotherapy patient in the world whose treatment was planned using new RapidPlan™ knowledge-based software from Varian Medical...
The French Cancer Institute is Building its Re-irradiation and Adaptive Radiotherapy Program Using the Latest Technology Developed by Accuray
When most people think of anatomy contouring, they think of the vital step that precedes treatment plan optimization, dose calculation, and plan evaluation. This is prospective contouring and is, indeed, an important step in the treatment planning workflow.
Varians Calypso® system is helping clinicians treat tumors more precisely by providing real-time targeting and motion management as well as accurate and efficient patient setup during radiotherapy.
Downloadable ! Author(s): Robert C. Feenstra & Tracy R. Lewis. 1991 Abstract: In a model where all factors of production are imperfectly mobile, we argue that the Dixit-Norman scheme of commodity taxes may not lead to strict Pareto gains from trade. Rather, this scheme must be augmented by policies which give factors an incentive to move: hence, the role for trade adjustment assistance (TAA). We demonstrate that by knowledge of the distribution of adjustment costs across individuals, the government can offer a single TAA subsidy to all individuals willing to move between industries, and maintain a non-negative budget. The TAA subsidy, combined with the Dixit-Norman pattern of commodity taxes, can lead to Pareto gains from trade under the conditions we identify.
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Last Remaining Pinnacle is the shoegazey noise rock of Dave Allison (and has been since 1995). Way back in 2011, Allison started working with guitarist Dave Dembitsky. The EP entitled Vistors is the result of their collaboration. This right here is track number three. Listen. Downloadable: Lies (mp3) You can pay-what-you-want for Visitors @ lastremainingpinnacle.bandcamp.com. […] more… ...
Laura Giangiuli is the vice president of human resources at CALIBRE Systems, Inc. and is a Pinnacle Awards finalist in the HR Executive of the Year
Pinnacles and Caversham Wildlife Park Day Tour in Perth is an amazing opportunity to explore the Australian coastline with the majestic views.