Search

This work examines the dosimetric performance of two algorithms creating a corrected CBCT (corrCBCT) and a virtual CT (vCT) implemented in a commercial treatment planning system. 60 patients distributed across all patient groups treated with curative intent at Vejle Hospital (breast, lung, prostate and anal/rectal cancer) were selected for the present study. Clinical treatment plans were recalculated on corrCBCT and vCT, as well as a reference CT (refCT) acquired as close in time to the CBCT image as possible. Recalculated doses were compared using gamma analysis, as well as by comparing D 98 % , D 50 % , and D 2 % for all delineated targets and organs at risk. High dosimetric accuracy is demonstrated on both the corrCBCT and vCT. Gamma 2 % / 2 mm pass rates > 98 % were found for all patients except two outliers still having > 93 % pass rates. Equivalence of all evaluated dose metrics within ± 1 Gy was observed for all patient groups, while the pelvic patients additionally showed equivalence for all metrics within ± 1 % of the refCT dose. For the thoracic patients, equivalence within ± 2. 5 % was established for all metrics except median dose to the ipsilateral lung, calculated on corrCBCT for the breast patient group. The corrCBCT and vCT images are shown in excellent dosimetric agreement with refCT images, and show high potential for future use for streamlined adaptive radiotherapy workflows. • Accurate CBCT based dose calculation is demonstrated using two different algorithms. • Both algorithms perform only post-processing and are CBCT-vendor agnostic. • Dose calculation accuracy is evaluated on 20 thoracic and 40 pelvic patients. • Gamma 2%/2 mm pass rates above 98% is shown for 58/60 patients. • Equivalence to CT-based dose within 1 Gy is shown for all evaluated dose metrics. [ABSTRACT FROM AUTHOR]

• There is a massive overuse of Caesarean sections (CSs) worldwide with no or very little benefit for the health of mother and newborn, also in low-income countries. • This study indicates that a personally adapted birthing room may reduce the CS rate. • The influence of the birthing environment on the neurohormonal physiological and psychological birth process needs to be considered when constructing and organising labour wards. To evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation. As part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate. In the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms. The results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes. [ABSTRACT FROM AUTHOR]

The research seeks to quantify the marginal cost impact of transportation cost drivers on the total operating cost of Texas's public schools and how these costs differ between district type and environment setting. The analysis tests the validity of often cited research findings examining the widely used School Bus Routing Problem (SBRP). We present results from fixed effects regressions with panel data for the total transportation operating cost. Finding the marginal cost of an additional student is 2.5 times greater for a rural district than for an urban district. Additionally, we compare mean average values of school bus transportation metrics between rural, town, suburban, and city districts. Concluding, on average, school bus transportation costs for Rural districts are 40% more per student than a City or Suburban district. The dataset includes eleven years of transportation operating costs from 998 Texas public school districts. • Urban school districts should adopt routing strategies to reduce the number of buses required, even if these strategies increase total mileage to minimize total operating costs. • Many rural school districts should adopt routing strategies to reduce total mileage without increasing the number of buses needed to minimize total operating costs. • The marginal cost of an additional student for a rural district is 2.5 times that of an urban district. • The marginal cost of an additional transportation mile for a rural district is more than ten times that of an urban district. • On average, Rural districts spend 40% more per student than City districts. [ABSTRACT FROM AUTHOR]

The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38–50) mm and 68 (IQR 58–85) mm, respectively. Mortality was 1.3% (95% CI 0.7–2.4) after eIAA repair and 25.5% (95% CI 18.0–34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair. [ABSTRACT FROM AUTHOR]

Aims: To quantify the relation between smoking cessation after a first cardiovascular (CV) event and risk of recurrent CV events and mortality.Methods: Data were available from 4,673 patients aged 61 ± 8.7 years, with a recent (≤1 year) first manifestation of arterial disease participating in the SMART-cohort. Cox models were used to quantify the relation between smoking status and risk of recurrent major atherosclerotic cardiovascular events (MACE including stroke, MI and vascular mortality) and mortality. In addition, survival according to smoking status was plotted, taking competing risk of non-vascular mortality into account.Results: A third of the smokers stopped after their first CV event. During a median of 7.4 (3.7-10.8) years of follow-up, 794 patients died and 692 MACE occurred. Compared to patients who continued to smoke, patients who quit had a lower risk of recurrent MACE (adjusted HR 0.66, 95% CI 0.49-0.88) and all-cause mortality (adjusted HR 0.63, 95% CI 0.48-0.82). Patients who reported smoking cessation on average lived 5 life years longer and recurrent MACE occurred 10 years later. In patients with a first CV event >70 years, cessation of smoking had improved survival which on average was comparable to former or never smokers.Conclusions: Irrespective of age at first CV event, cessation of smoking after a first CV event is related to a substantial lower risk of recurrent vascular events and all-cause mortality. Since smoking cessation is more effective in reducing CV risk than any pharmaceutical treatment of major risk factors, it should be a key objective for patients with vascular disease. [ABSTRACT FROM AUTHOR]

This paper examines the nexus of intelligence education and training from a South African perspective with the focus on current practices in light of the country's transition towards democracy. A brief overview is provided on the history and development of the South African intelligence community with specific focus on the civilian intelligence services from the period prior 1994 to date (2015). The main focus, however, is on intelligence education that is currently available from training institutions and universities in South Africa as registered with the Department of Higher Education as well as private training institutions on the one hand, and the intelligence training practices within the statutory intelligence environment on the other. To this extent, the relations between academic institutions and the intelligence structures in terms of education and training within South Africa are perused against other practices within the African continent and internationally. The approaches to the study of intelligence are also addressed within this paper. Likewise, the how, what as well as to whom -- pertaining to intelligence education and training availability and accessibility to students and practitioners within South Africa, is reviewed and analysed with the focus on making recommendations for the enhancement and improvement thereof to enable a focus on preparing the next generation of professional intelligence officers. [ABSTRACT FROM AUTHOR]

Many CCS research projects are confined to lab or pilot scale, others restrict themselves to one or two fields of interest such as capture or storage. The first Dutch national R&D programme on CCS (CATO) and its successor CATO2 have been organized as integrated, demand-driven research programmes with a clear focus on the support of pilot projects and demonstration projects at industrial scale in addition to fundamental research. The integration in CATO-2 provided additional value to our stakeholders. Such value creation is most prominent within the context of large integrated demonstration projects such as the ROAD project but is evident in most of our fundamental work too. This paper provides a brief overview of the results obtained in the CATO-2 programme in the past five year with a focus on the value of integration. [ABSTRACT FROM AUTHOR]

Objectives: To determine if the duration of wearing compression stockings after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) has influence on pain and quality of life. Methods: This was a prospective randomized controlled trial. Between December 2006 and February 2008, 109 consecutive patients with EVLA of the GSV were analyzed. Deep vein insufficiency, ulceration, more than one insufficient vein in one leg, and use of anticoagulants were exclusion criteria. Group A used compression stocking for 48 hours after therapy, group B for 7 days. Pain (visual analogue scale [VAS]) and quality of life (SF-36) were analyzed 48 hours, 1 week, and 6 weeks after therapy. Three months after treatment, duplex ultrasound imaging was performed to assess occlusion rates. Results: Both groups (group A, n = 37; group B, n = 32) where comparable at baseline. After 1 week, there was a significant difference in pain (VAS score 3.7 [±2.1] vs. 2.0 [±1.1], p ≤ .001), and physical dysfunction (group A, 85.1 [±11.2] vs. group B, 95.7 [±10.1]; p < .001) as well as vitality (group A, 75 [±13.0] vs. group B, 83.7 [±13.4]; p = .03), all in favor of group B, which disappeared after 6 weeks. After 6 weeks, no significant differences in all endpoints were present. Duplex ultrasound imaging revealed complete GSV occlusion in all patients, while no cases of deep venous thrombosis had developed. Conclusions: Prescribing compression stockings for longer than 2 days after endovenous GSV ablation (without simultaneous phlebectomies) leads to reduced pain and improved physical function during the first week after treatment. [Copyright &y& Elsevier]

Abstract: Introduction: The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. Method: A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. Results: Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. Discussion: The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to explore Swedish midwives’ experiences of management of third stage of labour. Design: six focus group discussions were performed and the analysis was based on content analysis. Setting: the midwives worked at six hospitals: three university hospitals and three provincial hospitals located from the south west to the north of Sweden. Participants: 32 midwives with extensive experience of assisting women in childbirth. Findings: the analysis generated three categories: ‘bring the process under control’, ‘protect normality and women''s birthing experiences’ and ‘maintain midwives’ autonomy’. This study demonstrates that management of the third stage of labour varies greatly. Not all midwives were convinced that administration of prophylactic oxytocin in the third stage of labour was always the best alternative for all women who had a normal birth. Key conclusions and implications for practice: the midwives exhibited self-confidence in evaluating the physiological process, and endeavoured to leave the physiological process undisturbed if no other risks were apparent. Their decisions concerning third stage management were based on a combination of previous experience, hospital guidelines, risk assessment and sensitivity to each woman''s needs. This study demonstrates that management of the third stage of labour varies greatly. The findings show the importance of reaching a balance between treating birth as a normal process and as a biomedical event. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the efficacy of endovenous laser ablation of incompetent perforating veins. Study design: Prospective cohort study. Patients: A total of 58 perforating veins in 33 limbs of 28 patients were treated between March 2008 and February 2009 in an outpatient clinic setting. The average age was 65 years (range 30–81 years); 64% female; CEAP clinical stage C4 (67%), C5 (17%) and C6 (16%) (Clinica, Etiology, Anatomy and Pathophysiology, CEAP). Methods: All patients underwent a standardised clinical examination and duplex ultrasonography. Guided by duplex ultrasonography, the perforating veins were cannulated percutaneously and tumescent local anaesthesia was given. An 810-nm diode laser was used to deliver 14 W power. Mean total energy delivered was 187 (range 87–325) J. Three months post-treatment, all patients underwent a further duplex ultrasound examination, to determine the treatment outcome. Results: Occlusion of the perforating veins was achieved after 3 months in 78% of the cases. In the CEAP C6 group, four of five ulcers had healed after 6 weeks. No serious complications, including deep venous thrombosis, were encountered. Conclusions: Endovenous laser therapy for treating incompetent perforating veins is a safe and technically feasible technique. The initial occlusion rate is acceptable. [Copyright &y& Elsevier]

The fundamental aerodynamic influence of downstream wheels on a front wing flow field and vice versa has been investigated using generic wind tunnel models. The research has been conducted using a wing with a fixed configuration, whereas the wing ride height with respect to the ground has been varied as the primary variable. The overlap and gap between the wing and wheels have been kept constant within the context of the current paper. At higher ride heights the wheels reduce wing downforce and increase wing drag, whereas the drag of the wheels themselves also rises. At low ride heights, however the opposite happens and the wing performance improves, while the wheels produce less drag. The ride height range has been subdivided into force regions with consistent characteristics throughout each of them. Force and pressure measurements, particle image velocimetry results, and oil flow images have been used to explain the differences between. the force regions and to derive the governing flow mechanisms. The trajectories and interaction of vortices play a dominant role in the observed force behavior both as force enhancing and reducing mechanisms. The effect of wheel circulation, flow separation, and flow channeling by the ground and by the wheels are among the other main contributors that have been discussed within this paper. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate treatment of the small saphenous vein (SSV) by endovenous laser ablation. Study design: A cohort study, occlusion of the vein and safety of the procedure was analysed prospectively. Patients: 150 consecutive patients (169 limbs) were treated between August 2006 and January 2008 in an outpatient clinic setting. The average age was 57 years (range 23–87); 82% female; 31% had serious varicose disease (CEAP 3–6). Treated length averaged 23cm (range 6–53cm). Methods: All patients underwent a standardised assessment comprising digital questionnaire, physical examination and duplex ultrasonography. The SSV was cannulated percutaneously under ultrasound control and perivascular local anaesthesia (tumescent) was injected. An 810nm diode laser was used, delivering 70J/cm. Three months post-treatment all patients received a duplex ultrasound of the treated vessel. Results: Complete occlusion of the SSV after 3 months was achieved in 98% of the cases. Two patients (1.3%) had sural nerve paraesthesia. Six patients developed superficial thrombophlebitis. Serious complications did not occur. Conclusions: Endovenous laser ablation for treating the incompetent small saphenous vein is a safe, effective and technically feasible technique. [Copyright &y& Elsevier]

After an introductory paragraph which supplies a cursory overview of all the ancient sources on mandrake, a well known and popular drug amongst the ancients, the article provides a systemization of information obtained from the three most significant ancient accounts of the mandrake plant. Dioscorides' Greek text contains the more precise account and is supplemented by the Latin works of Cornelius Celsus and Pliny the Elder. These authors give detailed information on the plant's physical appearance, the methods employed to harvest it, instructions on how to administer it, the dosages prescribed, the effects of overdosing, its toxicity and its soporific, anesthetic and other (alleged or real) medicinal properties. The second part of the article highlights some literary references to mandrake in sources as diverse as the Bible, a Shakespearean play and Rowling's recent best selling Harry Potter series. Finally a description of mandrake in modern pharmacological terms leads to some conclusions regarding its actual medicinal and homeopathic usefulness. [ABSTRACT FROM AUTHOR]

A procedure for numerical simulation of rail wear and the corresponding profile evolution has been formulated. The wear is assumed to be uniform in the sense that the profiles remain constant along the track portion to be investigated. A simulation set is selected defining the vehicles running on the track, their operating conditions, and contact parameters. Several variations of input data may be included together with the corresponding occurrence probability. Simulation of multi-body dynamics is used to calculate contact forces and positions, and Archard's wear equation is applied for the calculation of wear depth. Wear coefficients as a function of contact pressure and relative sliding velocity are collected from different test results. Trial calculations of four non-lubricated and two lubricated curves with radii from 303 to 802 m show qualitatively reasonable results in terms of profile shape development and difference in wear mechanisms between gauge corner and rail head. The wear rates related to traffic tonnage are, however, overestimated and the lubrication efficiency underestimated. It is expected that model refinements in terms of environmental influence and contact stress calculation are useful to improve the quantitative results. [ABSTRACT FROM AUTHOR]

High train speeds inside narrow double-track tunnels using light car bodies can reduce the ride comfort of trains as a consequence of the unsteadiness of the aerodynamics. This fact was substantiated in Japan with the introduction of the series 300 Shinkansen trains more than a decade ago, where the train speed is very high also in relatively narrow tunnels on the Sanyo line.The current work considers the resulting effects of vehicle dynamics and ride comfort with multi-body dynamics using a model of the end car of the German high-speed train ICE 2. The present efforts are different from traditional vehicle dynamic studies, where disturbances are introduced through the track only. Here disturbances are also applied to the car body, which conventional suspension systems are not designed to cope with.Vehicle dynamic implications of unsteady aerodynamic loads from a previous study are examined. These loads were obtained with large eddy simulations based on the geometry of the ICE 2 and Shinkansen 300 trains.A sensitivity study of some relevant vehicle parameters is carried out with frequency response analysis (FRA) and time domain simulations. A comparison of these two approaches shows that results which are obtained with the much swifter FRA technique are accurate also for sizable unsteady aerodynamic loads. FRA is, therefore, shown to be a useful tool to predict ride comfort in the current context.The car body mass is found to be a key parameter for car body vibrations, where loads are applied directly to the car body. For the current vehicle model, a mass reduction of the car body is predicted to be most momentous in the vicinity of 2 Hz. [ABSTRACT FROM AUTHOR]

Abstract: Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation accompanied by changes in motility. It is known that regulatory peptides like substance P (SP) are important pro-inflammatory peptides which are also involved in neuronal conduction. To get clues for new diagnostic and therapeutic approaches we describe the SP receptor (NK-1) distribution in IBD compared to control intestinal tissue, on mRNA and protein level by three complementary techniques. Autoradiography showed differences within the intestinal wall of control patients; mucosal binding was 17fmol/g and muscular binding was significantly (p =0.01) higher (98fmol/g). In inflamed specimens of patients with IBD mucosal SP binding was increased compared to controls (55±10 vs 18±4fmol/g mucosa, p =0.002). However RT-PCR showed that the mRNA content of the NK-1 receptor in these samples was not increased. In non-inflamed samples of patients with Crohn’s disease (CD) and ulcerative colitis (UC) SP binding was similar as in controls, while mRNA was significantly decreased in CD patients (0.7±0.02 vs 4.4±0.7, p =0.01) but not in UC patients (4.4±0.7 vs 4.1±1.4). Immunohistochemistry identified a broad spectrum of NK-1 receptor locations in control intestine. No aberrant expression in IBD was found. This study showed that although there was no difference in location of the SP receptors in IBD patients versus controls, the quantity of SP binding was significantly increased in the inflamed mucosa of IBD patients, while the mRNA level was not increased. Further a difference in mRNA level between non-inflamed tissue of CD and UC patients was shown, with mRNA in CD being lower. These changes in SP receptor expression during chronic inflammation suggest that SP receptors are a potential target for therapeutic regulation of the inflammatory response. [Copyright &y& Elsevier]

Tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCD) are widely used flame retardants that have increasingly been found as contaminants in the aquatic environment. In the present study, European flounder (Platichthys flesus) were chronically exposed to TBBPA; (105 days) and HBCD (78 days), in a wide range including environmentally relevant concentrations. TBBPA was administered via the water, whereas HBCD was administered in food and sediment, or in sediment alone. Chemical analysis of muscle showed an average increase in internal concentrations of approximately two orders of magnitude for both compounds tested. Animals exposed to HBCD via sediment alone (8000μg/g total organic carbon, TOC) showed a proportional increase of α-HBCD in muscle compared to animals exposed via food and sediment. In both studies, exposure to the test compounds did not affect general health and toxicity parameters (behavior, survival, growth rate, relative liver and gonad weight). Hepatic microsomal enzyme activities (TBBPA: EROD; HBCD: EROD, PROD, and BROD) were not induced by any of the tested chemicals. Aromatase activity in male gonads showed a mild increase with rising TBBPA levels. There were no morphological and immunohistochemical indications for increased production of the yolk precursor protein vitellogenin (VTG) in animals exposed to TBBPA and HBCD; immunochemical analysis of plasma VTG levels showed no dose response in animals exposed to TBBPA. In animals exposed to TBBPA, levels of the thyroid hormone thyroxin (T4) increased with internal concentrations of the test compound, possibly indicating competition of TBBPA for plasma protein binding. Triiodothyronin (T3) levels were not affected and histology showed no signs of altered thyroid gland activity. Other organs investigated (liver, gills, kidney, skin, and gonads) revealed no histological changes related to TBBPA or HBCD exposure. Overall, the present results indicate limited endocrine effects of these widely used flame retardants in a test species representative of European estuaries at environmentally relevant exposure levels and at internal levels up to 4300ng TBBPA/g wet weight, and 446μg HBCD/g lipid weight in flounder muscle. [Copyright &y& Elsevier]