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This study investigated the moisturizing action of a topical emulsion containing babassu coconut almond oil in xerotic skin volunteers treated or undergoing leprosy treatment. A total of 20 volunteers (16 men and 4 women, with a mean age of 52.2 ± 15.3) with cutaneous xerosis performed the tests after signing the informed consent form. The research subjects were instructed to use the product under investigation (Attalea speciosa almond oil gel-cream formulation) 1 (one) once a day, in two 15-day cycles: first with the gel-cream formulation with babassu oil (treatment A) and the second with the gel-cream formulation without babassu oil (treatment B). The moisturizing emulsion did not significantly alter (p> 0.05) the xerotic skin pH of the volunteers, treatment A (11.6 ± 0.1), treatment B (8.8 ± 0.2) and control (11.4 ± 0.2) at week W7, when compared to week W15, treatment A (11.0 ± 0.4), treatment B (11.6 ± 0.1) and control (11.4 ± 0.2). Clinical evaluations showed the efficacy and good tolerability of topical emulsion in the hydration of xerotic skin. The biophysical evaluation of the moisturizing emulsion proved the significant improvement of skin moisture.

Heterodyne techniques have been used to experimentally determine, for the first time, the frequencies for nineteen laser emissions ranging from 264 to 984 GHz. These laser emissions were generated by optically pumping either CH3CN, CD3CN, $^{13}\textit {CH}_{3}$ 13 CH 3 I, CD3I, or $^{13}\textit {CD}_{3}$ 13 CD 3 I with a CO2 laser. This includes the newly discovered 566.325-μ m laser emission from optically pumped $^{13}\textit {CD}_{3}$ 13 CD 3 I. The fractional uncertainties with which these frequencies were experimentally determined, up to ± 5 × 10− 7, were of sufficient accuracy to confirm or revise seven previously proposed far-infrared laser assignments.

Stated choice experiments are increasingly becoming popular due to their ability to optimize information gain with limited resources. Many designs have been developed for the selection of various attributes and their levels to form choice sets. One such design is blocked fractional factorial design (BFFD). Stated choice experiments for symmetric attributes of 4 choice sets of sizes 2 and 4 and 8 choice sets of sizes 2 and 4 were developed using BFFDs. Generators for the stated choice set of sizes 2 and 4 with resolution three, four, and five were developed. The alias structures and confounding effects for the designs were derived, as well as their clear effects if any for estimation. The A -efficiency was used to compute the efficiencies of the proposed designs since it has better statistical properties. The computed efficiencies for the proposed designs reveal that 4 choice sets of size 4 designs are more efficient. Finally, a practical application of the proposed method was carried out for four choice sets of size 4 using 2 V 5 − 1 − 2 design with attributes and levels of service quality in public transport.

Coronavirus disease 2019 (COVID-19) placed additional strain on an already struggling health care system. In response, novel solutions such as telehealth have been explored, however, there is significant room for innovation in health care delivery.The aim of our study was to evaluate the effectiveness of a drive-through medical treatment system for evaluating patients with COVID-like symptoms.We designed a prototype drive-through medical treatment facility (DMF) to triage large volumes of patients quickly and efficiently, while fully evaluating, treating, and discharging low-risk patients. A retrospective chart review was performed to extract clinical and logistical metrics.A total of 2164 patients were evaluated between May 1 and July 1, 2020. Overall accuracy for patient classification was 92.4% (95% confidence interval [CI] 91.2-93.5%). Screening criteria resulted in a return with need for workup or admission rate of 0.25%, yielding a sensitivity of 83.3% (95% CI 65.3-94.4%). Of those presenting to the DMF, 179 patients (8.3%) were diverted to the main emergency department (ED) for further evaluation, of which 14% received diagnostic workups and 5% subsequent admission to an inpatient service, yielding a specificity of 92.8% (95% CI 91.7- 93.9%). Length of stays for those seen in the DMF vs. the main ED (M = 38 min vs 149 min) yielded a mean difference of 111 min per encounter and a total time savings of 3762 h.Drive-through medical systems can accurately triage patients presenting with potential COVID-19 and effectively treat lower-risk patients, thereby reducing ED utilization.

To better serve women with gynaecological cancers, we need a sound understanding of their health, wellbeing and needs. This study sought to explore these issues in a sample of Australian women before commencing curative radiotherapy.We undertook a secondary analysis of baseline data from a supportive care trial (n = 311). Descriptive statistics were used to summarise responses to measures of wellbeing, general psychological distress, symptom distress, sexual function and vaginal changes, and supportive care needs. Pre-specified regression models were used to examine sources of variation in wellbeing and sexual function.Women reported lower emotional, functional and physical wellbeing than population norms (all p0.001). The prevalence of general psychological distress was 31% (95% CI 26-36%). Distress caused by physical symptoms was typically low. Health system and information needs comprised eight of the top ten moderate-to-high supportive care needs. Most women reported no change in interest for physical contact or sex compared to pre-diagnosis, but some sexually active women (16-24%) reported smaller vaginal size, increased dryness, and more pain on intercourse. General psychological distress was a robust marker of poorer wellbeing and sexual function.Before radiotherapy, a substantial minority of women with gynaecological cancers experience general psychological distress, reduced wellbeing and moderate-to-high health system and information needs. A model of comprehensive care incorporating assessment of unmet needs, general psychological distress, and sexual issues is recommended. Healthcare providers may require training to elicit and respond to a constellation of interrelated issues and access relevant services for women requiring additional support.

Radiation therapy is a common cancer treatment, requiring timely information to help patients prepare for treatment. We pilot tested a low literacy, psycho-educational talking book (written booklet, with accompanying audio recording) to examine (i) the effect of the tool on knowledge, anxiety and communication; (ii) acceptability, and (iii) how it was used in appointments.A pre-post design was employed. Patients scheduled to receive radiation therapy for any cancer were recruited from two hospitals in Sydney, Australia. Participants were sent the talking book before treatment planning and completed baseline and follow-up surveys, before and after the intervention.Forty participants were recruited, and 39 completed all study assessments. Overall, knowledge increased after receiving the talking book by 3.8 points from 13.9 to 17.7/20 (95% confidence interval (CI) 2.7, 4.8, P 0.001). Anxiety and concerns were significantly lower after receiving the talking book (P = 0.015 and P = 0.004, respectively). Nearly half of participants (s = 17, 48%) reported using the book during appointments. Most reported finding it easier to communicate (n = 31, 89%) and to ask more questions (n = 21, 62%).The talking book shows promise in improving knowledge, reducing anxiety and enhancing communication. Strategies to support the implementation of the talking book are required. Further studies to translate the book into different languages are also planned.

The study involved 1240 women covering the ten administrative regions of Ghana. The aim was to study the prevalence of maternal mortality and its distribution across the ten regions based on given demographic factors. Three main analytical methods were used: Direct estimation method, Fay-Herriot method and Binary Logistic regression. The study revealed that prevalence of maternal mortality in Ghana was high among women engaged in manual works, rural dwellers, women living without partners and women living in pro-poor families. The Northern region had the highest number of maternal deaths followed by the Western region whilst the Ashanti and the Upper East regions had the lowest number of maternal deaths. There is therefore the need for Ghana Health Service to engage all stakeholders in checking maternal mortality in the country.

Supp fig 1-8: Figure S1. Inhibition of SLC1A5 Expression in A431 cells. Figure S2. Screen and Validation of Hits. Figure S3. IMD-0354 inhibited Glutamine Uptake. Figure S4. IMD-0354 Suppresses Glutamine Uptake Independent of IKK-NF- B Signaling Suppression. Figure S5. Profiles of IMD-0354-Treated A375 Cells Matched with Small-Molecule Inhibitors and Melanoma Subtypes. Figure S6. Expression of Glutamine Deprivation-Related Genes. Figure S7. Inhibition of Melanoma Growth with IMD-0354 in combination with LDHA or GLS1 Inhibitors. Figure S8. Immunohistochemistry Staining of Xenograft Tumor Samples.

Supp Tables 1-2: Table S1 List of hits selected from the primary screen. Table S2. Chemical structures of hits selected for validation.

Purpose The purpose of this paper is to establish the mediating role of local government delivery system (here after delivery system) in the relationship between local governance (hereafter, governance) and financial distress of local governments in Uganda. Design/methodology/approach This study is correlational and cross-sectional. It uses a questionnaire survey on a sample of 109 local governments (districts) of Uganda. The data are analysed using SPSS, partial least squares structural equation modelling and Jose’s MedGraph. Findings Results indicate that government delivery system mediates the relationship between governance and financial distress. Delivery system in terms of capacity development and community participation causes positive variances in local government’s financial distress. Also, governance in terms of political clientelism significantly contributes to financial distress more than oversight mechanisms and audit quality. The study finds that delivery system causes more variance in financial distress than governance. Originality/value This study applies the new public management and network governance theory and tests the efficacy of delivery system and governance on financial distress in one-go and succeeded in explaining financial distress of local government using Uganda as the setting; the authors join previous scholars that root for multi-theoretical approaches. Also, this study’s design has allowed for the consideration of more than simply the main effects of governance and delivery systems by exploring the mediating role of delivery systems in the link between governance and financial distress. As such, the authors may now have a more accurate and detailed description of the relationships between governance, delivery system and local government financial distress.

Clinical diagnostic sequencing of circulating tumour DNA (ctDNA) is well advanced for adult patients, but application to paediatric cancer patients lags behind.To address this, we have developed a clinically relevant (67 gene) NGS capture panel and accompanying workflow that enables sensitive and reliable detection of low-frequency genetic variants in cell-free DNA (cfDNA) from children with solid tumours. We combined gene panel sequencing with low pass whole-genome sequencing of the same library to inform on genome-wide copy number changes in the blood.Analytical validity was evaluated using control materials, and the method was found to be highly sensitive (0.96 for SNVs and 0.97 for INDEL), specific (0.82 for SNVs and 0.978 for INDEL), repeatable (0.93 [95% CI: 0.89-0.95]) and reproducible (0.87 [95% CI: 0.87-0.95]). Potential for clinical application was demonstrated in 39 childhood cancer patients with a spectrum of solid tumours in which the single nucleotide variants expected from tumour sequencing were detected in cfDNA in 94.4% (17/18) of cases with active extracranial disease. In 13 patients, where serial samples were available, we show a close correlation between events detected in cfDNA and treatment response, demonstrate that cfDNA analysis could be a useful tool to monitor disease progression, and show cfDNA sequencing has the potential to identify targetable variants that were not detected in tumour samples.This is the first pan-cancer DNA sequencing panel that we know to be optimised for cfDNA in children for blood-based molecular diagnostics in paediatric solid tumours.

Sweetpotato (Ipomoea batatas) is the sixth most important food crop and plays a critical role in maintaining food security worldwide. Support for sweetpotato improvement research in breeding and genetics programs, and maintenance of sweetpotato germplasm collections is essential for preserving food security for future generations. Germplasm collections seek to preserve phenotypic and genotypic diversity through accession characterization. However, due to its genetic complexity, high heterogeneity, polyploid genome, phenotypic plasticity, and high flower production variability, sweetpotato genetic characterization is challenging. Here, we characterize the genetic diversity and population structure of 604 accessions from the sweetpotato germplasm collection maintained by the United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Plant Genetic Resources Conservation Unit (PGRCU) in Griffin, Georgia, United States. Using the genotyping-by-sequencing platform (GBSpoly) and bioinformatic pipelines (ngsComposer and GBSapp), a total of 102,870 polymorphic SNPs with hexaploid dosage calls were identified from the 604 accessions. Discriminant analysis of principal components (DAPC) and Bayesian clustering identified six unique genetic groupings across seven broad geographic regions. Genetic diversity analyses using the hexaploid data set revealed ample genetic diversity among the analyzed collection in concordance with previous analyses. Following population structure and diversity analyses, breeder germplasm subsets of 24, 48, 96, and 384 accessions were established using K-means clustering with manual selection to maintain phenotypic and genotypic diversity. The genetic characterization of the PGRCU sweetpotato germplasm collection and breeder germplasm subsets developed in this study provide the foundation for future association studies and serve as precursors toward phenotyping studies aimed at linking genotype with phenotype.

The translation initiation complex 4F (eIF4F) is a rate-limiting factor in protein synthesis. Alterations in eIF4F activity are linked to several diseases, including cancer and infectious diseases. To this end, coronaviruses require eIF4F complex activity to produce proteins essential for their life cycle. Efforts to target coronaviruses by abrogating translation have been largely limited to repurposing existing eIF4F complex inhibitors. Here, we report the results of a high throughput screen to identify small molecules that disrupt eIF4F complex formation and inhibit coronavirus RNA and protein levels. Of 338,000 small molecules screened for inhibition of the eIF4F-driven, CAP-dependent translation, we identified SBI-1232 and two structurally related analogs, SBI-5844 and SBI-0498, that inhibit human coronavirus OC43 (HCoV-OC43; OC43) with minimal cell toxicity. Notably, gene expression changes after OC43 infection of Vero E6 or A549 cells were effectively reverted upon treatment with SBI-5844 or SBI-0498. Moreover, SBI-5844 or SBI-0498 treatment effectively impeded the eIF4F complex assembly, with concomitant inhibition of newly synthesized OC43 nucleocapsid protein and OC43 RNA and protein levels. Overall, we identify SBI-5844 and SBI-0498 as small molecules targeting the eIF4F complex that may limit coronavirus transcripts and proteins, thereby representing a basis for developing novel therapeutic modalities against coronaviruses.

ObjectivesIn this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the care of a neurologist or neurosurgeon and how such admissions vary by levels of deprivation.DesignRetrospective empirical research employing a derived list of neurological emergency diagnostic codesSettingThis study used the Hospital Episode Statistics data set for the financial year 2019/2020 based on 17 million in-year inpatient admissions in England including 6.5 million (100%) emergency admissions with any diagnosis codes.ResultsThere were 1.4 million (21.2%) emergency inpatient admissions with a mention of any neurological code, approx. 248 455 (3.8%) with mention of a specific neurological emergency code from the derived list, and 72 485 (1.1%) included such a code as the primary reason for admission. The highest number of in-year admissions for adults was for epilepsy (145 995), with epilepsy as the primary diagnostic code in 15 945 (10.9%). Acute nerve root/spinal cord syndrome (41 215), head injury (29 235) and subarachnoid haemorrhage (18 505) accounted for the next three highest number of admissions. 3230 (1.4%) in-year emergency hospital admissions with mention of a neurological emergency code were under the care of a neurologist or neurosurgeon, with only 1315 (0.9%) admissions with mention of an epilepsy code under a neurologist. There was significant variation for epilepsy and functional neurological disorders (FNDs) in particular by Index of Multiple Deprivation decile. The association between deprivation and epilepsy and FND was significant with p-values of 2.5e-6 and 1.5e-8, respectively.ConclusionsThis study has identified important findings in relation to the burden of neurological emergency admissions but further work is needed, with greater clinical engagement in diagnostic coding, to better understand the implications for workforce and changes to service delivery needing to be implemented.

The physiology of living beings presents oscillations that are known as biological rhythms. The most studied rhythm is called circadian (circa = circa, dies = day), because it varies with a period close to 24h. Most functions of the body have circadian variations, one can mention, for example, metabolism, body temperature, the activity of the nervous system, secretion of hormones such as melatonin and cortisol. Circadian rhythms were also found in human behavior, for example: in sensory activity, motor activity, reaction time, visual perception, auditory perception, time perception, attention, memory, arithmetic calculus, and executive functions. The present work reviews the visual path that participates in the synchronization of circadian rhythms, as well as the evidence that exists about the presence of circadian rhythms in the sensation and visual perception of the human being.

Introduction: Weakness is a common chief complaint in the emergency department, and the use of glucocorticoids is pervasive in medicine. Muscle weakness, or myopathy, is a well documented side effect of chronic glucocorticoid use. However, acute myopathy, with an onset shortly after initiation of glucocorticoids, is much rarer. Case Report: We present a case of acute steroid-induced myopathy after a single intra-articular dose of triamcinolone in a young, healthy, active male. To our knowledge, this is the first case described in the medical literature of acute steroid-induced myopathy following a single intra-articular injection. Conclusion: In a patient who presents with proximal muscle weakness and has a history of glucocorticoid use, the diagnosis of steroid-induced myopathy should be considered. Acute steroid-induced myopathy should be high on the differential in a patient who presents with typical symptoms and has been prescribed glucocorticoids for less than 14 days or, in rare cases, may have recently received a single dose of glucocorticoids. Treatment is supportive and outpatient management is typically indicated, as respiratory muscle involvement is rare.

In his foundational text The Twenty Years’ Crisis: An Introduction to the Study of International Relations (1939), E. H. Carr juxtaposes utopian and realist approaches to world politics. This dicho...

This paper proposes a stepwise confidence set procedure for identifying equivalence or safety of compounds in a toxicity study under heteroscedasticity of variances for a normally distributed data. The problem of statistical methodology for drug safety is the control of the familywise error rate (FWER). Hence, we construct a confidence set procedure for toxicological evaluation and incorporating the partitioning principle with a case of heteroscedascity of variances under normal assumption. Our simulation studies demonstrated that the power of the procedures for heterogeneity of variances increases with increasing in ratio of means.

Purpose A 5 and 10 μm thin silicon on insulator (SOI) 3D mushroom microdosimeter was used to characterise both the in-field and out-of-field of a 62 MeV proton beam. Methods The SOI mushroom microdosimeter consisted of an array of cylindrical sensitive volumes (SVs), developed by the Centre for Medical Radiation Physics, University of Wollongong, was irradiated with 62 MeV protons at the CATANA (Centro di AdroTerapia Applicazioni Nucleari Avanzate) facility in Catania, Italy, a facility dedicated to the radiation treatment of ocular melanomas. Dose mean lineal energy, ( y D ¯ ), values were obtained at various depths in PMMA along a pristine and spread out Bragg peak (SOBP). The measured microdosimetric spectra at each position were then used as inputs into the modified Microdosimetric Kinetic Model (MKM) to derive the RBE for absorbed dose in a middle of the SOBP 2Gy (RBED ). Microdosimetric spectra were obtained with both the 5 and 10 μm 3D SOI microdosimeters, with a focus on the distal part of the BP. The in-field and out-of-field measurement configurations along the Bragg curve were modelled in Geant4 for comparison with experimental results. Lateral out-of-field measurements were performed to study secondary particles' contribution to normal tissue's dose, up to 12 mm from the edge of the beam field, and quality factor and dose equivalent results were obtained. Results Comparison between experimental and simulation results showed good agreement between one another for both the pristine and SOBP beams in terms of y D ¯ and RBED . Though a small discrepancy between experiment and simulation was seen at the entrance of the Bragg curve, where experimental results were slightly lower than Geant4. The dose equivalent value measured 12 mm from the edge of the target volume was 1.27 ± 0.15 mSv/Gy with a Q ¯ value of 2.52 ± 0.30, both of which agree within uncertainty with Geant4 simulation. Conclusions These results demonstrate that SOI microdosimeters are an effective tool to predict RBED in-field as well as dose equivalent monitoring out-of-field to provide insight to probability of second cancer generation.

We propose a stepwise confidence procedure for identifying minimum effective dose (MED) without multiplicity adjustment.Stepwise procedures strongly control the familywise error rate (FWER) which is a critical requirement for statistical methodologies in identification of MED. The partitioning principle is invoked to validate the control of the FWER. Our simulation study indicates that the FWER was properly controlled in the case with balanced design but failed in some cases of sample sizes for situations of unbalanced design. In addition, the power of the procedure increases with increasing mean of ratio differences and the sample sizes.

Neural mechanisms are traditionally examined from different theoretical angles. Similarly, social neuroscience emphasizes the important role that the social environment and neural systems play in the development of social behavior. Thus, this study aims to describe how social neuroscience uses the brain mapping theory and hypothesis testing approach to explain the functioning of social cognition. This approach points out that brain areas, such as the ventromedial prefrontal cortex (vmPFC), lateral temporal cortex, and dorsal anterior cingulate cortex, are specialized in processing social information. These areas are also linked to the regulation of interpersonal relationships, social cooperation, values, empathy, and moral behavior. However, how does social neuroscience explain the phenomena of social behavior? What is the explanation of the social self? Social neuroscience has theoretical and methodological features that bring it closer to a paradigm of social research and neuroscience; the form of mechanistic analysis of biological and cognitive structures broadly describes a neurocognitive mechanism for explaining human social behavior.

Despite the low contribution of heavy ions to the total fluence in the space radiation environment, their radiobiological effect on the human body is extremely high. In this article, we investigated the radiation field which resulted from the interaction of galactic cosmic rays (GCRs), specifically some heavy ions and energies, typically encountered in space with a realistic multilayer sample of the International Space Station (ISS) Columbus module’s shielding wall. The quality factor, Q, and the normalized dose equivalent, H, derived from microdosimetric measurements for C, Ne, and Si ions behind different spacecraft wall configurations and materials are presented in this article. Particularly, carbon fiber, polyoxymethylene, and perspex with same areal density compared to currently used aluminum were investigated.

This paper draws lessons from the Ebola Virus Disease epidemic to suggest how health systems research can be strengthened to assist better with preparedness for and mitigation of future public health emergencies The epidemic killed more than 11 000 people in West Africa between February 2014 and January 2016 The causes of the epidemic and the response to the outbreak harbour many lessons concerning how health systems were overwhelmed and need to be re-designed in order to cope with future public health emergencies and limit their escalation From these lessons, it is possible to identify the most significant systemic issues that must be addressed to ensure health systems can exhibit greater resilience in the face of similar events in the future The paper goes on to consider the current capacity of health systems research (HSR) to assist with the management of these issues and to suggest that critical systems thinking and practice could empower health systems researchers and practitioners in a manner that would give them much greater potency The research has additional importance now that Covid-19 has demonstrated that pandemics are not ‘black swan’ events © 2021 John Wiley & Sons, Ltd

Summary Apelin receptor (APLNR/AGTRLl1/APJ) marks a transient cell population during the differentiation of hematopoietic stem and progenitor cells (HSPCs) from pluripotent stem cells, but its function during the production and maintenance of hematopoietic stem cells is not clear. We generated an Aplnr-tdTomato reporter mouse embryonic stem cell (mESC) line and showed that HSPCs are generated exclusively from mesodermal cells that express Aplnr-tdTomato. HSPC production from mESCs was impaired when Aplnr was deleted, implying that this pathway is required for their production. To address the role of APLNR signaling in HSPC maintenance, we added APELIN ligands to ex vivo AGM cultures. Activation of the APLNR pathway in this system impaired the generation of long-term reconstituting HSPCs and appeared to drive myeloid differentiation. Our data suggest that the APLNR signaling is required for the generation of cells that give rise to HSCs, but that its subsequent downregulation is required for their maintenance., Graphical abstract, Highlights • Aplnr-tdTomato reporter marks a subpopulation of ESC-derived mesoderm • Hematopoietic differentiation is impaired in Aplnr-null ESCs • HSC activity within AGM explant cultures is reduced in the presence of Aplnr ligands • Aplnr signaling drives the maturation of lineage-committed myeloid progenitors, In this article, Lesley Forrester and colleagues use genetically engineered embryonic stem cells and explant cultures of embryonic aorta-mesonephros tissue to show that APLNR signaling is required for the generation of cells that give rise to hematopoietic cells but that its subsequent downregulation is required for the maintenance of hematopoietic stem cells.

Radiation environments in space are mainly composed of protons coming from the Galactic Cosmic Rays (GCRs) pervading the universe, the Solar Particle Events (SPEs) resulting from solar flares and coronal mass ejections, and the two Van Allen Belts surrounding the Earth due to the presence of the geomagnetic field trapping charged particles. Their wide spectra of energies up to hundreds of GeV imply diverse radiobiological effects to astronauts and radiation damage to electronics in the spacecraft. Even if lower in abundance, heavy ions such as He, C, O, Si, Fe are present in space and constitute an even bigger hazard due to their high penetrability and high linear energy transfer (LET). Most irradiation facilities available for research and testing worldwide provide usually only monoenergetic beams of high-energy protons or other heavier particles limiting studies of radiobiological effects and effects on electronics to a set of discrete energies. This paper introduces a procedure where a proton fluence spectra of interest for space radiation protection, previously generated by Monte Carlo simulations was delivered using a clinical proton therapy accelerator. Particularly, it reports the first results of modelling a proton radiation field in space in the energy range from 70 to 230 MeV during a single experimental session by programming a treatment planning system (TPS) to deliver required proton irradiation energies. Moreover, the angular distribution of the proton irradiation field has been varied to reproduce the isotropic exposure experienced by humans in space. The obtained proton radiation field was characterized using a 3D sensitive volume SOI microdosimeter developed by the Centre for Medical Radiation Physics (CMRP), University of Wollongong, Australia.

Obesity is a serious, chronic, and progressive disease associated with physiological dysfunctions that interact with circadian clock activity. Vertical gastrectomy (VG) is currently the most freque...

Purpose Stereotactic radiosurgery (SRS) can be delivered with a standard linear accelerator (linac). At institutions having more than one linac, beam matching is common practice. In the literature, there are indications that machine central axis (CAX) matching for broad fields does not guarantee matching of small fields with side ≤2 cm. There is no indication on how matching for broad fields on axis translates to matching small fields off axis. These are of interest to multitarget single‐isocenter (MTSI) SRS planning and the present work addresses that gap in the literature. Methods We used 6 MV flattening filter free (FFF) beams from four Elekta VersaHD® linacs equipped with an Agility™ multileaf collimator (MLC). The linacs were strictly matched for broad fields on CAX. We compared output factors (OPFs) and effective field size, measured concurrently using a novel 2D solid‐state dosimeter “Duo” with a spatial resolution of 0.2 mm, in square and rectangular static fields with sides from 0.5 to 2 cm, either on axis or away from it by 5 to 15 cm. Results Among the four linacs, OPF for fields ≥1 × 1 cm2 ranged 1.3% on CAX, whereas off axis a maximum range of 1.9% was observed at 15 cm. A larger variability in OPF was noted for the 0.5 × 0.5 cm2 field, with a range of 5.9% on CAX, which improved to a maximum of 2.3% moving off axis. Two linacs showed greater consistency with a range of 1.4% on CAX and 2.2% at 15 cm off axis. Between linacs, the effective field size varied by

Objective Radiotherapy for gynaecological cancer is associated with multiple adverse effects. This randomised controlled trial evaluated the impact of a combined nurse- and peer-led psycho-educational intervention on psychological distress, preparation for treatment, quality of life, psychosexual function, unmet needs and vaginal stenosis. Methods Eligible women had a confirmed diagnosis of gynaecological cancer, scheduled to receive radiotherapy with curative intent, aged ≥18 years, and able to read and write English. Participants randomly assigned one-to-one to either four nurse-led consultations plus four peer-led telephone sessions, or to usual care. Participants completed study measures at baseline, immediately before first radiotherapy (FU1), and four weeks (FU2), three (FU3), six (FU4), and 12 months (FU5) post radiotherapy. The primary outcomes were psychological distress at FU1 and FU2 measured by the Hospital Anxiety and Depression Scale. Results Of 840 eligible participants, 625 were approached and 319 (51%) consented; 158 assigned to intervention, 160 to usual care with 1 withdrawing before randomisation. Between-groups differences for primary outcomes were trivial- and small-sized, (both p > 0.05). Notable effects on secondary outcomes favouring the intervention at FU2 included preparation for treatment (sensory/psychological concerns, d = 0.57; and procedural concerns, d = 0.52) and specific needs domains (sexuality needs, d = 0.38; and health system and information needs, d = 0.41). Conclusions There was no evidence that a nurse- and peer-led intervention had a beneficial effect on psychological distress compared to usual care. However, improved treatment readiness and lower health system and sexuality needs indicate the intervention may have addressed outcomes known to be important to this population.

BackgroundThis paper describes the protocol for the Nano X Image Guidance (Nano X IG), a single-institution, clinical imaging study. The Nano X is a prototype fixed-beam radiotherapy system developed to investigate the feasibility of a low cost, compact radiotherapy system to increase global access to radiation therapy. This study aims to assess the feasibility of volumetric image guidance with Cone Beam Computed Tomography (CBCT) acquired during horizontal patient rotation on the Nano X radiotherapy system.MethodsIn the Nano X IG study we will determine whether image guidance can be performed with the Nano X radiotherapy system, to a clinically acceptable and usable standard for radiotherapy. We will acquire both conventional CBCT scans and Nano X CBCT scans, where the patient is horizontally rotated while scan projections are acquired, for 30 patients. For each patient a panel of experts will assess the image quality of Nano X CBCT scans against conventional CBCT scans. Each patient will receive two Nano X CBCT scans to determine the image quality reproducibility, the extent and reproducibility of patient motion and assess patient tolerance.DiscussionFixed-beam radiotherapy systems have the potential to help ease the current shortfall and increase global access to radiotherapy treatment. Advances in image guidance could facilitate fixed-beam radiotherapy using horizontal patient rotation. The efficacy of this radiotherapy approach is dependent on our ability to image and adapt to motion due to rotation and for patients to tolerate rotation during treatment.Trial registrationThis study was registered on ClinicalTrials.gov on 27 July 2020. The identifier is: NCT04488224.

This study aimed to verify the daily variation in the chromatic visual sensitivity of healthy subjects. The study included 35 male adults, aged between 20 and 40 years old (M = 24.97; SD = 4.9). Th...

We describe the unusual case of a clinically significant subdural haematoma without any underlying cause in a term baby delivered by an elective caesarean section, which required surgical evacuation. We review the literature and describe the presentation, investigation and management options in infants with this infrequent condition.

In this article, we propose stepwise confidence set procedure for toxicity evaluation based on ratio of means difference under unknown and unequal variance across dose groups. The procedure is based on construction of confidence interval at various dose levels without multiplicity adjustment so that the familywise type one error (FWER) will be well-controlled. The results from our simulation study indicate that the FWER was properly control in the case with balanced design but failed in some cases of sample sizes for situations of unbalanced design. Also, the power of the procedure increases with increasing with mean of ratio differences and the sample sizes COVID-19 is the disease caused by the novel coranavirus, which outbreaked in one community, Wuhan