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A low-cost consumer-grade spectroscopic system offers potential applications in many fields. Linear variable optical filters (LVOFs) placed in front of imaging sensors are one of the most promising avenues to realize this goal. In this work, we built a spectroscopic system by depositing an LVOF directly onto the protective window of OV5647 color and OV9281 monochrome imaging sensors for the Raspberry Pi. The ¼" sensors cost $15-$80 CAD at the time of writing and have linear dimensions of only 2.7 – 3.6 mm. To achieve a suitable gradient over such small sensors, an ultra-slow shutting system was built for the physical vapor deposition of an SiO 2 gradient layer between two partially transparent silver mirrors to form a miniature LVOF. The resulting devices operated as effective low-cost spectrometers that were single-moded in the visible spectrum. These simple systems were finally used to measure spectra from sample light sources, clearly illustrating the advantages and limitations of this simple and economical approach towards everyday consumer spectroscopy. [ABSTRACT FROM AUTHOR]

The translation of research into clinical practice is challenging and implementation science is becoming as important as the trial design and development. Implementation science methodologies have been shown to reduce research-to-practice gap in other clinical settings. This is especially true for the field of Radiation Oncology where modern hypofractionated techniques, like Stereotactic Ablative Body Radiotherapy for Liver are at a high risk of over enthusiastic implementation as well as underutilization. We present the results of a multicomponent implementation methodology utilized to develop our Liver SBRT program as a model to safely translate a complex technology into clinical practice. After review of literature and market research a setup was created with focus on machine requirements, immobilization devices, motion management techniques and QA techniques. Clinical tools in the form of checklists were developed for patient selection, simulation along with image fusion, target delineation, planning (conformity indices, dose constraint criteria) and treatment delivery. All patients were treated on Truebeam® after Bodyfix® immobilization with plastic wrap. Planning was completed on Eclipse TPS with dose constraints and conformity guidelines defined per the RTOG 1112 and TG 101. Clinical outcomes including clinical and imaging follow-up for tumor control and toxicity were recorded. For this report, all patients treated were reviewed and compared to published data to assess the success of the implementation methodology. A total of 64 consecutive Patients treated with liver SBRT at Dignity Health Cancer Institute (DHCI) were eligible for the study. 58 patients treated for primary liver malignancies were included in this analysis to assess outcomes including control of disease and toxicity to compare to the published literature. Median follow up for these patients 6.5 months (4-46mnths). Median GTV volume was 38.7cc (0.1cc-2056.1 cc), median PTV volume was 159.35 cc (21.5cc-2673.5cc). Median SBRT prescription dose was 50 Gy/5 fractions (35-50 Gy). Median Liver- GTV was 1595.8 cc(770.7cc-2983.0cc). Following toxicities were noted- Grade 1- 10.3%, Grade 2 – 1.72%, Grade 3- 3.44%. No Grade 4 toxicity was noted. 1 year LC rate was 96.6%. 8.6% showed out of field liver failure and 6.9% developed distant metastasis. These results were compared to the current published literature and are shown to be comparable. Strong and well thought out Implementation methodologies can ensure reproducing results in clinical practice, comparable to the controlled environment of trials. These are crucial in translation of clinical trials utilizing advanced technologies to promote the culture of safety in clinical practice of Radiation Oncology. Regular assessment and tracking of clinical outcomes can be used as Quality markers for directing care and reimbursements for future. [ABSTRACT FROM AUTHOR]

Severe mitral regurgitation (MR) is often a complicating factor in patients with heart failure with reduced ejection fraction (HFrEF) presenting with acute cardiogenic shock (CS). Early mechanical circulatory support (MCS) with percutaneous modalities such as veno-arterial (VA) ECMO and Impella allow for hemodynamic stabilization and bridging to durable therapy or recovery. This case report describes a HFrEF patient in cardiogenic shock with MR initially stabilized with combined VA ECMO and Impella CP (ECPELLA) support, and later transitioned to Impella 5.5 therapy that enabled successful transcatheter edge-to-edge repair (TEER) of the mitral valve and eventual recovery. A 64-year-old with HFrEF was admitted to an outside hospital with HF exacerbation and recurrent ventricular tachyarrhythmias. He acutely decompensated into refractory CS despite a combination of vasoactive infusions and femoral Impella CP support. Our rapid ECMO deployment (RED) team mobilized and cannulated the patient on site. Two days later, we exchanged an Impella CP to an axillary Impella 5.5 to facilitate ECMO weaning. At that time, his transesophageal echocardiogram revealed severe MR of mixed functional and primary etiology due to a flail A2/A3 anterior leaflet and tethered posterior leaflet resulting in a wide coaptation gap. He was successfully decannulated from peripheral VA ECMO two days later. Although his cardiac function stabilized with Impella 5.5 and an inotrope, he was unable to be weaned from MCS due to MR. Evaluations by heart failure, structural heart, and cardiac surgery recommended against durable LVAD and conventional surgery, but felt his mitral valve was amenable to percutaneous repair. He eventually underwent successful TEER with 2 XTW clips to A2-P2 segment and 1 XT clip to the A2-P2. Residual mitral valve gradient was 4 mmHg and left atrial pressure went from 46/61/26 to 23/28/20 mmHg. Patient was weaned post-procedure from Impella 5.5 and was discharged to in-patient rehab. This case is one of the first descriptions of successful MitraClip repair while on Impella 5.5 support, specifically, and highlights the vital importance of a collaborative heart team approach in the management of patients with cardiogenic shock. [ABSTRACT FROM AUTHOR]

Fall risk does not significantly impact on the efficacy of the bisphosphonate clodronate in reducing the incidence of fracture. The debate about the efficacy of skeletal therapies on fracture risk in women at increased risk of falling continues. We determined whether fall risk impeded the efficacy of clodronate to reduce osteoporotic fracture incidence. This is a post hoc analysis of a 3-year placebo-controlled study of bisphosphonate clodronate involving 5,212 women aged 75 years or more. At entry, self-reported multiple falls in the previous month and ability to rise from a chair were documented. Their interaction with treatment efficacy was examined using Poisson regression. Oral doses of clodronate at 800 mg daily reduced osteoporotic fracture incidence by 24% (hazard ration (HR) 0.76, 95% confidence interval 0.63–0.93). The efficacy was similar in women with recent multiple falls compared to those without (HR 0.61 vs. 0.77, p value for interaction >0.30) or impaired ability in rising compared to those with no impairment (HR 0.79 vs. 0.74, respectively; p value > 0.30). Fall risk does not significantly impact on the anti-fracture efficacy of clodronate. If confirmed with other agents, fall risk may be incorporated into risk assessment tools designed to target skeletal therapies. [ABSTRACT FROM AUTHOR]

Fracture risk prediction can be enhanced by the concurrent assessment of other clinical risk factors. This study demonstrates that the estimation of an individual’s 10-year probability of fracture by the FRAX® algorithm identifies patients at high risk of fracture who will respond to bisphosphonate therapy. Treatments for osteoporosis are targeted largely to patients with low bone density (BMD) or a prior fragility fracture. Fracture risk prediction can be enhanced by the concurrent assessment of other clinical risk factors, but it is important to determine whether the risk so identified can be reduced by intervention. We determined the effect of a bisphosphonate on fracture rates when risk was calculated using a new risk algorithm (FRAX®). Women aged 75 years or more were recruited to a randomised, double-blind controlled trial of 800 mg oral clodronate (Bonefos®) daily over 3 years. Baseline clinical risk factors were entered in the FRAX® model to compute the 10-year probability of major osteoporotic fractures with or without input of femoral neck BMD. The interaction between fracture probability and treatment efficacy was examined by Poisson regression. In 3,974 women, the interaction between fracture probability and treatment efficacy was significant when probability was assessed without BMD ( p = 0.043), but not when BMD was included ( p = 0.10). Efficacy was more evident in those deemed at highest risk. For example women lying at the 75th percentile of fracture probability in the absence of BMD (10-year probability 24%) treatment reduced fracture risk by 27% (HR 0.73, 95%CI 0.58–0.92). In those with a fracture probability of 30% (90th percentile), the fracture risk reduction was 38% (HR 0.62, 0.46–0.84). The estimation of an individual’s 10-year probability of fracture by the FRAX® algorithm identifies patients at high risk of fracture who will respond to bisphosphonate therapy. [ABSTRACT FROM AUTHOR]