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Byline: Anil. Kumar, M. Gopalakrishnan, Manish. BeniwalRadiation-induced brachial plexus neuropathy (RIBPN) is a rare, devastating but a relatively well-described complication that occurs after radiotherapy in the vicinity of the brachial [...]

Byline: Lukas. Rasulic, Vikram. Singh, M. Gopalakrishnan, K. RaoSocolovsky et al .;, have provided a comprehensive review detailing the pathophysiological mechanisms and management strategies for neuropathic pain.[1]Brachial plexus and peripheral [...]

BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. METHODS: Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). RESULTS: Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. CONCLUSIONS: Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended. [ABSTRACT FROM AUTHOR]

The success behind effective project management lies in estimating the time for individual activities. In many cases, these activity times are non-deterministic. In such situations, the conventional method (project evaluation and review technique (PERT)) obtains three time estimates, which are then used to calculate the expected time. In practice, it is often difficult to get three accurate time estimates. A recent paper suggests using just two time estimates and an approximation of the normal distribution to obtain the expected time and variance for that activity. In this paper, we propose an alternate method that uses only two bits of information: the most-likely and either the optimistic or the pessimistic time. We use a lognormal approximation and experimental results to show that our method is not only better than the normal approximation, but also better than the conventional method when the underlying activity distributions are moderately or heavily right skewed. doi: 10.1057/palgrave.jors.2602204 Published online 3 May 2006 Keywords: PERT; lognormal distribution; estimation; probability

As the survival rates of childhood cancer improve, it becomes increasingly important to study the impact of multi-modality therapies on long-term health. Radiotherapy has been implicated as a contributor to late toxicities such as second malignant neoplasms and cardiovascular disease; however, there are still significant gaps in knowledge. Indeed, survivors presenting with late health effects today were treated before the widespread availability of 3D imaging and radiotherapy planning. However, without 3D organ dosimetry, it is difficult to translate the knowledge gained from past treatments into the dose tolerance criteria needed for improving outcomes for patients treated today. The National Wilms Tumor Study (NWTS) provides a unique opportunity to bridge this gap. This paper describes the methods, workflow, and results of a multi-year effort to reconstruct radiotherapy organ doses for the NWTS cohort in support of late effects research. We reconstructed 3D organ doses for 4716 pediatric patients in the NWTS cohort. As CT images were not available for the NWTS patients, computational phantoms were selected from a body-size dependent phantom library to use as surrogate anatomy. Each patient was matched to a phantom in the library based on gender, height, and weight at age of Wilms tumor diagnosis. A DICOM CT image set and structure file for the matched phantom was then imported into a treatment planning system (TPS) for reconstruction of the radiotherapy fields according to paper medical records. The radiotherapy planning was performed by an experienced medical physicist under the supervision of a radiation oncologist familiar with protocols used during the NWTS trials. As the accuracy of the TPS is limited in the out-of-field region, Monte Carlo radiation transport calculations were also performed to improve the organ dose estimates. All calculations were performed on the NIH high-performance computing cluster. The patients were treated with a variety of photon energies: 4 MV (23%), 6 MV (48%), 10 MV (3%), Co-60 (23%), and other (3%). The most common treatment fields were left and right-flank, abdomen, and chest. The Monte Carlo dose calculations took approximately ~100 CPU hours (wall clock time ~2 hours) for a typical patient, resulting in approximately 0.5 million CPU hours in total for the cohort. Mean organ dose and dose-volume metrics were computed for more than 100 organs or tissues. This study represents the first time Monte Carlo methods have been directly applied on a large scale to reconstruct organs doses for an epidemiological cohort. The organ doses for the NWTS cohort will provide valuable information for developing dose tolerance criteria for mitigating radiotherapy toxicity. [ABSTRACT FROM AUTHOR]

A growing concern on the accumulation and disposal of fish processing discards and environmental degradation induces a profound attraction on the development of valuable byproducts for human purposes. Gelatin was isolated from Siboga squid (Doryteuthiis sibogae) skin through cold maturation process and its physico-chemical as well as structural properties viz. Water Holding Capacity (WHC), emulsifying capacity, emulsifying stability and viscosity were analyzed. The alkaline treatment of skin yielded 7.5 % gelatin powder. Extracted gelatin was characterized using UV-visible spectroscopy, ¹H NMR, FT-IR and Raman analyses. Based on FT-IR and Raman fingerprints, peak located at 1664 cm-1 (C=O stretch Amide I band) could be inferred that secondary structure of proteins as well as coiled structure of gelatin. Topographic analysis by AFM showed presence of aggregates of the polymer. The results suggest that the Siboga squid gelatin is an alternative source of gelatin and its potential applicability at industrial scale. [ABSTRACT FROM AUTHOR]