Search

The objectives of this systematic review and meta-analyses are (1) to estimate the prevalence of hypovitaminosis D in fracture patients and (2) to summarize the available evidence on the efficacy of vitamin D supplementation in fracture patients.A comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases was conducted. Conference abstracts from relevant meetings were also searched.We included studies that investigate vitamin D insufficiency or examine the effect of vitamin D supplementation on 25-hydroxy-vitamin D (25(OH)D) serum levels in fracture patients.Two authors independently extracted data using a predesigned form.We performed a pooled analysis to determine the prevalence of postfracture hypovitaminosis D and mean postfracture 25(OH)D levels. We present detailed summaries of each of the studies evaluating the impact of vitamin D supplementation.The weighted pooled prevalence of hypovitaminosis D was 70.0% (95% confidence interval: 63.7%-76.0%, I = 97.7). The mean postfracture serum 25(OH)D was 19.5 ng/mL. The studies that evaluated the efficacy of vitamin D supplementation suggest that vitamin D supplementation safely increases serum 25(OH)D levels. Only 1 meeting abstract showed a trend toward reduced risk of nonunion after a single large loading dose of vitamin D.This review found a high prevalence of hypovitaminosis D in fracture patients and that vitamin D supplementation at a range of doses safely increases 25(OH)D serum levels. To date, only 1 pilot study published as a meeting abstract has demonstrated a trend toward improved fracture healing with vitamin D supplementation.Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The relationship between data-privacy lawmakers and genomics researchers may have gotten off on the wrong foot. Critics of protectionism in the current laws advocate that we abandon the existing paradigm, which was formulated in an entirely different medical research context. Genomic research no longer requires physically risky interventions that directly affect participants' integrity. But to simply strip away these protections for the benefit of research projects neglects not only new concerns about data privacy, but also broader interests that research participants have in the research process. Protectionism and privacy should not be treated as unwelcome anachronisms. We should instead seek to develop an updated, positive framework for data privacy and participant participation and collective autonomy. It is beginning to become possible to imagine this new framework, by reflecting on new developments in genomics and bioinformatics, such as secure remote processing, data commons, and health data co-operatives.

The sharing and linking of medical data across borders is now a key enabler of new medical discoveries. Data are no longer simply collected and used at a single physical site, such as a laboratory or a research institute. Instead, communication flows between research teams within and across national borders bring together the necessary data and expertise to clarify previously unknown disease aetiologies. Integration of medical data and secure health records systems now allows clinicians to develop early treatment strategies tailored to a specific patient. As policymakers, patient advocacy groups, and biomedical researchers gravitate toward recognizing the benefits of global data sharing, they may be challenged by regulatory systems that were developed when the norm was using and sharing medical data only within a single jurisdiction. This chapter describes and compares key data privacy legal frameworks (Canada, US, UK, EU, Council of Europe, OECD) and discusses data sharing policies adopted by major biomedical research funding organisations (the NIH, Canadian Institutes of Health Research, Genome Canada, Wellcome Trust) in the context of their impact on medical data privacy. In so doing, the chapter explains not only the content, significance, and practical usefulness of these laws, regulations, and policies as they relate to medical data, but also identifies lingering barriers to global data sharing and suggests ways to overcome them while maintaining robust data privacy protection.

The final state of the tumor at the end of a radiotherapy course is dependent on the doses given in each fraction during the treatment course. This study investigates the feasibility of a novel method, Dynamic Adaptive Radiotherapy (DART) that adapts treatment plans using a dynamic programming technique to consider the expected changes of the tumor in the optimization process. DART allows for non-stationary dose distributions as well as non-stationary fractional doses as needed to achieve a series of optimal plans that are conformal to the tumor over time. We applied this method to the treatment of non-small cell lung cancer and quantified potential dosimetric advantages over conventional IMRT.Sixteen phantom cases with various sizes and locations of tumors and organs-at-risk (OAR) were generated. Each case was planned with DART and conventional IMRT prescribing 60Gy/30fx. The observations of the change in the tumor volume over a treatment course were simulated using two-level cell population model. Monte Carlo simulations of the treatment course for each case were run to account for uncertainty in the tumor response. The same OAR dose constraints were applied for both methods. The frequency of replanning was varied between 1, 2, 5(weekly), and 29(daily). The average tumor maximum, minimum, mean dose, and D95 resulting from DART were 124.0-125.2%, 102.1-114.7%, 113.7-123.4%, and 102.0-115.9% of those from conventional IMRT. The ranges represent the spread in doses as a function of the frequency of replanning. The maximum dose for the cord and esophagus, mean dose for the heart and lungs, and D05 for the unspecified tissues resulting from the plans using DART were 84-102.4%, 99.8-106.9%, 66.9-85.6%, 58.2-78.8%, and 85.2-94.0% of those from conventional IMRT respectively. Significant increases in the tumor dose and reductions in the OAR dose, particularly for parallel OAR with mean or dose-volume constraints, could be achieved using DART.

Purpose: To investigate the impact of using spatiotemporal optimization, i.e., intensity modulated spatial optimization followed by fractionation schedule optimization, to select the patient-specific fractionation schedule that maximizes the tumor biologically equivalent dose (BED) under dose constraints for multiple organs-at-risk (OAR).Methods: The optimal fractionation schedule for a patient using the linear-quadratic (LQ) cell survival model depends on the tumor and OAR sensitivity to fraction size, the effective tumor doubling time (Td), and the size and location of tumor target relative to one or more OAR (dose distribution). We used a spatiotemporal optimization method to identify the optimal number of fractions N that maximizes the 3D tumor BED distribution for sixteen lung phantom cases. The 15 selection of the optimal fractionation schedule used equivalent (30-fraction) OAR constraints for the heart (Dmean 45 Gy), lungs (Dmean 20 Gy), cord (Dmax 45 Gy), esophagus (Dmax 63 Gy), and unspecifed tissues (D05 60 Gy). To assess plan quality, we compared the minimum, mean, maximum, and D95 of tumor BED, as well as the equivalent uniform dose (EUD) for optimized plans to conventional IMRT plans prescribing 60 Gy in 30 fractions. A sensitivity analysis was 20 performed to assess the effects of Td (3 to 100 days), tumor lag-time (Tk = 0 to 10 days), and the size of tumors on optimal fractionation schedule.Results: Using an alpha/beta ratio of 10 Gy, the average values of tumor max, min, mean BED, and D95 were up to 19%, 21%, 20%, and 19% larger than those from conventional prescription, depending on Td and Tk used. Tumor EUD was up to 17% larger than the conventional prescription. For fast 25 proliferating tumors with Td less than 10 days, there was no significant increase in tumor BED but the treatment course could be shortened without a loss in tumor BED. The improvement in the tumor mean BED was more pronounced with smaller tumors (p-value = 0.08).Conclusions: Spatiotemporal optimization of patient plans has the potential to significantly improve local tumor control (larger BED/EUD) of patients with a favorable geometry, such as 30 smaller tumors with larger distances between the tumor target and nearby OARs. In patients with a less favorable geometry and for fast growing tumors, plans optimized using spatiotemporal optimization and conventional (spatial-only) optimization are equivalent (negligible differences in tumor BED/EUD). However, spatiotemporal optimization yields shorter treatment courses than conventional spatial-only optimization. Personalized, spatiotemporal optimization of treatment 35 schedules can increase patient convenience and help with the efficient allocation of clinical resources. Spatiotemporal optimization can also help identify a subset of patients that might benefit from non-conventional (large dose per fraction) treatments that are ineligible for the current practice of stereotactic body radiation therapy.

Tumor boundary delineation using positron emission tomography (PET) is a promising tool for radiation therapy applications. In this study we quantify the uncertainties in tumor boundary delineation as a function of the reconstruction method, smoothing, and lesion size in head and neck cancer patients using FDG-PET images and evaluate the dosimetric impact on radiotherapy plans. FDG-PET images were acquired for eight patients with a GE Advance PET scanner. In addition, a 20 cm diameter cylindrical phantom with six FDG-filled spheres with volumes of 1.2 to 26.5 cm{sup 3} was imaged. PET emission scans were reconstructed with the OSEM and FBP algorithms with different smoothing parameters. PET-based tumor regions were delineated using an automatic contouring function set at progressively higher threshold contour levels and the resulting volumes were calculated. CT-based tumor volumes were also contoured by a physician on coregistered PET/CT patient images. The intensity value of the threshold contour level that returns 100% of the actual volume, I{sub V100}, was measured. We generated intensity-modulated radiotherapy (IMRT) plans for an example head and neck patient, treating 66 Gy to CT-based gross disease and 54 Gy to nodal regions at risk, followed by a boost to the FDG-PET-based tumor. The volumes ofmore » PET-based tumors are a sensitive function of threshold contour level for all patients and phantom datasets. A 5% change in threshold contour level can translate into a 200% increase in volume. Phantom data indicate that I{sub V100} can be set as a fraction, f, of the maximum measured uptake. Fractional threshold values in the cylindrical water phantom range from 0.23 to 0.51. Both the fractional threshold and the threshold-volume curve are dependent on lesion size, with lesions smaller than approximately 5 cm{sup 3} displaying a more pronounced sensitivity and larger fractional threshold values. The threshold-volume curves and fractional threshold values also depend on the reconstruction algorithm and smoothing filter with more smoothing requiring a higher fractional threshold contour level. The threshold contour level affects the tumor size, and therefore the ultimate boost dose that is achievable with IMRT. In an example head and neck IMRT plan, the D95 of the planning target volume decreased from 7770 to 7230 cGy for 42% vs 55% contour threshold levels. PET-based tumor volumes are strongly affected by the choice of threshold level. This can have a significant dosimetric impact. The appropriate threshold level depends on lesion size and image reconstruction parameters. These effects should be carefully considered when using PET contour and/or volume information for radiotherapy applications.« less

In early 1980 an extension agent was assigned to the rural municipality of Bangui, Ilocos Norte, Philippines to work on development projects – in particular the improvement of the supply of safe water for drinking and sanitation. After many months of visiting spring sites and meeting with community leaders, a small part of the municipality was selected to build a gravity fed piped water system. Although the system took many months to plan, identify funding and construct, the 600 community members were ultimately rewarded with house to house connections that enabled them to achieve per capita water consumption levels above the minimum levels recommended by the World Health Organization. Of course, money was critical to ensure the project’s success, but many other factors played an equally critical role. For instance, without the active participation of the community and the unwavering support of the community leadership the project would not have survived the initial planning stage. Also, the extension agent played a critical role by acting as a conduit between funding agencies, the Bureau of Public Works and the community. The primary lesson to be learned from this experience is that the success of rural development projects is largely driven by the synergy between the community, technical support, financial support, and agents of change such as extension agents. If any of these ingredients had been lacking, the project result would likely have been far different.

Characterization measurements and calculations were performed on a new medical seed developed by IsoRay Inc. in Richland, Washington, that utilizes the short-lived isotope 131Cs. This is the first medical seed to utilize 131Cs, and this model has recently received FDA 510(k) clearance. The objective of this work was to characterize the dosimetric properties of the new seed according to the AAPM Task Group 43 recommendations. Cesium-131 is a low-energy x-ray emitter, with the most prominent peaks in the 29 keV to 34 keV region. The intended application is brachytherapy for treating cancers in prostate, breast, head and neck, lung, and pancreas. The evaluations performed included air-kerma strength, radial dose function, anisotropy in phantom, half-life, energy spectra in phantom and in air, and internal activity. The results indicate the CS-1 seeds have a dose-rate constant of 0.911 cGy hr-1 U-1 in water, dose penetration characteristics similar to 125I and 103Pd, anisotropy function values on the order of 0.71 at short distances and small angles, and an average anisotropy factor of 0.964. The overall dosimetric characteristics are similar to 125I and 103Pd seeds with the exception of half-life, which is 9.7 days, as compared to 17 days for 103Pd and 60 daysmore » for 125I. The shorter half-life may offer significant advantages in biological effectiveness.« less

The purpose is to incorporate clinically relevant factors such as patient-specific and dosimetric information as well as data from clinical trials in the decision-making process for the selection of prostate intensity-modulated radiation therapy (IMRT) plans. The approach is to incorporate the decision theoretic concept of an influence diagram into the solution of the multiobjective optimization inverse planning problem. A set of candidate IMRT plans was obtained by varying the importance factors for the planning target volume (PTV) and the organ-at-risk (OAR) in combination with simulated annealing to explore a large part of the solution space. The Pareto set for the PTV and OAR was analysed to demonstrate how the selection of the weighting factors influenced which part of the solution space was explored. An influence diagram based on a Bayesian network with 18 nodes was designed to model the decision process for plan selection. The model possessed nodes for clinical laboratory results, tumour grading, staging information, patient-specific information, dosimetric information, complications and survival statistics from clinical studies. A utility node was utilized for the decision-making process. The influence diagram successfully ranked the plans based on the available information. Sensitivity analyses were used to judge the reasonableness of the diagram and the results. In conclusion, influence diagrams lend themselves well to modelling the decision processes for IMRT plan selection. They provide an excellent means to incorporate the probabilistic nature of data and beliefs into one model. They also provide a means for introducing evidence-based medicine, in the form of results of clinical trials, into the decision-making process.

The design of large superpressure balloons has received significant attention in recent years due to the successful demonstration of various enabling technologies and materials. Of particular note is the “pumpkin” shaped balloon concept, which allows the stress in the envelope to be limited by the surface geometry. Unlike a sphere, where the radius used to determine the stress is determined by the volume of the balloon, the pumpkin utilizes a system of meridional tendons to react the loading in one direction, and form a number of lobes, which limit the stress in the circumferential direction. A suitable superpressure balloon has been designed using this technology which will carry 2 kg in the atmosphere of Mars. The deployment of this balloon is assumed to occur while falling on a decelerator suitably designed for the Mars atmosphere. The inflation is accomplished by a 10 kg system suspended at the nadir of the balloon. As the system falls toward the surface of the planet, helium gas is transferred into the balloon, forming a partially inflated system very similar to an ascending zero pressure balloon. This analysis incorporates the flow of the planetary gas around the inflating balloon which alters the pressure distribution and shape. As a result, stresses are seen to increase beyond the design values which will require the balloon to be redesigned to accommodate this type of dynamic deployment.

The questions I want to raise here first presented themselves to me in a pointed way during an undergraduate class on historiography. I had recently published a social and intellectual biography of a little-known mid fifteenth-century Florentine merchant and memorialist named Marco Parenti, whose anonymous history of a failed revolt against the Medici I had discovered in the Florentine archives.1 The collapse of the anti Medicean faction must have made it expedient to hide the narrative, and over time both the unfinished history and the would-be historian had faded into nearly total obscurity a condition that seemed to make Parenti an ideal subject for microhistory, that favourite form of late twentieth-century historical writing. My students had perhaps not taken away from the book as much as I would have wanted about the forms and traditions of Renais sance historical writing. Still, they appeared to have enjoyed the more concrete elements of this narrative of ideas, especially the mix of political intrigue, intimate social detail, and strong personality preserved in the family correspondence that was my chief biographical resource. But along side these narrative pleasures, there was also some nervousness about how much to trust this Rosencrantz and Guildenstern vision of a period they were accustomed to thinking of in grander terms. One student in particu lar stays in my memory because he was prepared to put his doubts quite bluntly, as well as to extend them to other, more notable representatives of the genre the lousy Cathar peasants, massacred cats, deluded millers, and returned 'husbands' he had encountered in more than one of his under graduate history courses. My protestations that these microhistorians had found a new way to represent ordinary lives and everyday experience were simply waved away: 'Aren't you really saying that your generation came too late to get the really important stuff the lives of people like Cosimo de' Medici or Lorenzo the Magnificent so really there was not much left over for you to write about except this bunch of odd balls and small potatoes?' Since my first defence had met only limited success, I improvised a new direction that in retrospect has come to seem more fruitful because more historical. I asked them to consider a choice between two quite different accounts of the battle of Stalingrad. The first book presents this crucial battle in a form that is traditional to military histories: that is, it provides a tactical narrative of the conflict and analyzes the success of the Soviet command in outmanoeuvring the German army, so that the invaders found themselves encircled and cut off from all supplies, surrender finally being their only option. Alternately they might want to read a rather different sort of narrative, one that, deliberately ignoring the larger strategic

Purpose: A standard tool for ensuring the quality of radiation therapy treatments is the initial physics plan review. However, little is known about its performance in practice. The goal of this study is to measure the effectiveness of physics plan review by introducing simulated errors into “mock” treatment plans and measuring the performance of plan review by physicists. Methods: We generated six mock treatment plans containing multiple errors. These errors were based on incident learning system data both within the department and internationally (SAFRON). These errors were scored for severity and frequency. Those with the highest scores were included in the simulations (13 errors total). Observer bias was minimized using a multiple co-correlated distractor approach. Eight physicists reviewed these plans for errors, with each physicist reviewing, on average, 3/6 plans. The confidence interval for the proportion of errors detected was computed using the Wilson score interval. Results: Simulated errors were detected in 65% of reviews [51–75%] (95% confidence interval [CI] in brackets). The following error scenarios had the highest detection rates: incorrect isocenter in DRRs/CBCT (91% [73–98%]) and a planned dose different from the prescribed dose (100% [61–100%]). Errors with low detection rates involved incorrect field parameters in record and verify system (38%, [18–61%]) and incorrect isocenter localization in planning system (29% [8–64%]). Though pre-treatment QA failure was reliably identified (100%), less than 20% of participants reported the error that caused the failure. Conclusion: This is one of the first quantitative studies of error detection. Although physics plan review is a key safety measure and can identify some errors with high fidelity, others errors are more challenging to detect. This data will guide future work on standardization and automation. Creating new checks or improving existing ones (i.e., via automation) will help in detecting those errors with low detection rates.

The effect of the community composition of soil microbes on ecosystem processes has received relatively little attention. Here we examined the variation in soil microbial composition in a Yellowstone National Park grassland and the effect of that variation on the growth, in a greenhouse, of the dominant grass in the community. Plants and their rhizospheric soil were collected from paired, Poa pratensis-dominated grassland plots located inside and outside a 40-year-old exclosure. P. pratensis aboveground, belowground, and whole plant growth were greater in pots with soil communities from grazed grassland compared to fenced grassland, indicating (1) soil microbial communities differed, and (2) this difference influenced the growth of the plant that dominated both grasslands. Treating pots with fungicide (benomyl) suppressed the soil community influence, indicating that different fungal communities caused the soil microbe effect. In addition, two lines of evidence are consistent with the hypothesis that arbuscular mycorrhizal fungal (AMF) species composition affected P. pratensis: (1) a divergence in AMF spore communities in the two field soils, and (2) little evidence of pathogenic fungi. These findings emphasize the need to examine the role that the composition of the soil microbial community plays in controlling terrestrial ecosystems.

The shiitake mushroom industry produces a waste product in the form of spent hardwood logs that have been partially digested by the lignicolous fungi, Lentinula edodes. Currently, there is no economically viable mechanism for disposal of these logs. The objectives of this research were to test several methods of composting chipped shiitake logs and to evaluate the use of the compost material for spinach (Spinacia oleracea L.) production. Four methods for producing compost from spent shiitake logs were compared: (a) in-vessel tumbler; (b) wire mesh cage; (c) passively aerated static pile; and (d) actively aerated static pile. Compost was produced from a mixture of 85% chipped spent shiitake logs and 15% grass clippings. In order to adjust C:N to 30:1. urea was added. Scale and production cost of the aerated static pile methods were superior to the other two methods. The resulting compost contained relatively high concentrations of Ca and low concentrations of P. Composting of chipped shiitake logs...

Irradiation of the cranio-spinal axis is often one of the treatment modalities of certain childhood cancers, e.g., medulloblastoma. In order to achieve a uniform dose to the spinal cord, missing tissue compensators are required. In the past, our practice was to fabricate compensators out of strips of lead. We report on the use of intensity modulated fields to achieve the desired compensation. Seven cases of pediatric cancer whose treatment involved irradiation of the cranio-spinal axis had compensators designed using a beam intensity modulation method rather than making mechanical compensators. The compensators only adjusted for missing tissue along the spinal axis. Comparisons between calculated and measured doses were made at depth in phantoms and on the surface of the patient. The intensity modulated fields were delivered using a step-and-shoot delivery on an Elekta SL20 accelerator equipped with multileaf collimator. The intensity-modulated compensators provided more flexibility in design than the physical compensator method. Finer intensity steps were achievable, more accurate dose distributions were able to be calculated, and adjustments during treatment, e.g., junction changes, were more easily implemented. Convolution/superposition dose calculations were within 3 of measurements. Intensity modulated fields are a practical and more efficient method of delivering uniform doses to the spine in pediatric cancer treatments. They provide many advantages over mechanical compensators with regard to time and flexibility. 2003 American College of Medical Physics.

Nineteenth-century historians and critics attacked the works of their Enlightenment predecessors as dry, abstract, and overly rational, yet eighteenth-century authors also placed considerable stress on the need for emotional involvement in the reading of history. Using the idea of historical distance, this essay shows that two forms of distance operated in the historical works of this period. On cognitive grounds, Enlightenment historians were committed to a theory of explanation that demanded considerable abstraction. In affective terms, however, the moral psychology of Hume, Smith, and Kames emphasized that history's potential for moral instruction depends on the writer's ability to reduce emotional distance. Actuality rather than exemplarity became the watchword of historical narration as readers were invited to appreciate history in ways that were strongly influenced by the contemporary culture of sensibility.

Intensity modulated radiation therapy (IMRT) theoretically allows detailed tailoring of the dose distribution in tissue. The goal of this study was to determine if a method of dynamic IMRT could be used to deliver a high dose of radiation to a concave shaped target around the cervical spinal cord. Fifteen young adult dogs from our laboratory population were randomly divided into two groups. A radiation dose of 84 Gy in 4 Gy fractions was delivered with a conventional 4 field technique for Group A dogs, and with dynamic IMRT for Group B dogs to a "C-shaped" target close to the cervical spinal cord. Neurologic status, magnetic resonance imaging results and histopathologic changes were compared among dogs in the two groups. Group A dogs developed myelomalacia with a latency period of 65 +/- 9 days. Group B dogs did not have any histologic changes to the cervical spinal cord when euthanasia was performed 12 months after irradiation. The results demonstrate that this IMRT technique can be safely and precisely delivered to a patient in a clinical situation.

This paper reports on the dosimetric effects of random and systematic modulator errors in delivery of dynamic intensity modulated beams. A sliding-widow type delivery that utilizes a combination of multileaf collimators (MLCs) and backup diaphragms was examined. Gaussian functions with standard deviations ranging from 0.5 to 1.5 mm were used to simulate random positioning errors. A clinical example involving a clival meningioma was chosen with optic chiasm and brain stem as limiting critical structures in the vicinity of the tumour. Dose calculations for different modulator fluctuations were performed, and a quantitative analysis was carried out based on cumulative and differential dose volume histograms for the gross target volume and surrounding critical structures. The study indicated that random modulator errors have a strong tendency to reduce minimum target dose and homogeneity. Furthermore, it was shown that random perturbation of both MLCs and backup diaphragms in the order of sigma = 1 mm can lead to 5% errors in prescribed dose. In comparison, when MLCs or backup diaphragms alone was perturbed, the system was more robust and modulator errors of at least sigma = 1.5 mm were required to cause dose discrepancies greater than 5%. For systematic perturbation, even errors in the order of +/- 0.5 mm were shown to result in significant dosimetric deviations.

(2003). Product Development through University-SME Collaboration: Lessons from Reactive and Proactive Approaches. Local Economy: Vol. 18, No. 1, pp. 91-95.

History is usually assumed to be a single, unified, and rather decorous genre, but a strong case can be made for thinking of historical writing as a family of overlapping and competing genres, “low” as well as “high.” Membership in this family changes over time, but in addition to national history it has included such bodies of writing as philosophical history, memoir, biography, literary history, and antiquities. What, then, differentiates these genres? Since all histories deal with temporality and the modifications of temporal distance, the construction of historical distance is a central feature of all forms of historical representation and as such provides a key reference point for historiographical analysis. The essay review two important cases of genre formation – literary history in early nineteenth-century Britain and micro-history in late twentieth century Europe and the United States – in order to show how attention to the construction of historical distance provides an analytic tool for examining some of the key features of these two emergent genres of historical writing.

Shiitake (Lentinula edodes (Berk.) Pegler) mushroom production in the United States has increased greatly over the last twenty years. Additional expansion of the shiitake mushroom market should be possible if the product can be marketed as a functional food, i.e., a food that has health-promoting effects beyond its nutritional value. High-molecular-weight polysaccharides (HMWP) including lentinan in shiitake may promote human health. This study was conducted to determine if management protocols influence the HMWP of shiitake mushrooms. Results indicate that measuring the total carbohydrate content of water-extractable, ethanol-insoluble polysaccharides was a simple way to estimate HMWP. Results also indicate that log-grown shiitake contained more HMWP than did substrate-grown shiitake. Among log-grown shiitake, both mushroom strain and tree species influenced HMWP content. The results suggest that there is considerable variation among shiitake mushrooms in HMWP content and that production protocols influenced the HMWP content of mushrooms.

Purpose: This study investigates the feasibility of personalizing radiotherapy prescription schemes (treatment margins and fractional doses) for glioblastoma (GBM) patients and their potential benefits using a proliferation and invasion (PI) glioma model on phantoms. Methods and Materials: We propose a strategy to personalize radiotherapy prescription schemes by simulating the proliferation and invasion of the tumor in 2D according to the PI glioma model. We demonstrate the strategy and its potential benefits by presenting virtual cases, where the standard and personalized prescriptions were applied to the tumor. Standard prescription was assumed to deliver 46 Gy in 23 fractions to the initial, gross tumor volume (GTV1) plus a 2 cm margin and an additional 14 Gy in 7 fractions to the boost GTV2 plus a 2 cm margin. The virtual cases include the tumors with a moving velocity of 0.029 (slow-move), 0.079 (average-move), and 0.13 (fast-move) mm/day for the gross tumor volume (GTV) with a radius of 1 (small) and 2 (large) cm. For each tumor size and velocity, the margin around GTV1 and GTV2 was varied between 0–6 cm and 1–3 cm, respectively. Equivalent uniform dose (EUD) to normal brain was constrained to the EUD value obtained by using the standard prescription. Various linear dose policies, where the fractional dose is linearly decreasing, constant, or increasing, were investigated to estimate the temporal effect of the radiation dose on tumor cell-kills. The goal was to find the combination of margins for GTV1 and GTV2 and a linear dose policy, which minimize the tumor cell-surviving fraction (SF) under a normal tissue constraint. The efficacy of a personalized prescription was evaluated by tumor EUD and the estimated survival time. Results: The personalized prescription for the slow-move tumors was to use 3.0–3.5 cm margins for GTV1, and a 1.5 cm margin for GTV2. For the average- and fast-move tumors, it was optimal to use a 6.0 cm margin for GTV1 and then 1.5–3.0 cm margins for GTV2, suggesting a course of whole brain therapy followed by a boost to a smaller volume. It was more effective to deliver the boost sequentially using a linearly decreasing fractional dose for all tumors. Personalized prescriptions led to surviving fractions of 0.001–0.465% compared to the standard prescription, and increased the tumor EUDs by 25.3–49.3% and estimated survival times by 7.6–22.2 months. Conclusions: Personalizing treatment margins based on the measured proliferative capacity of GBM tumor cells can potentially lead to significant improvements in tumor cell kill and related clinical outcomes.

Objective:The HIPPO trial is a UK randomized Phase II trial of hippocampal sparing (HS) vs conventional whole-brain radiotherapy after surgical resection or radiosurgery in patients with favourable prognosis with 1–4 brain metastases. Each participating centre completed a planning benchmark case as part of the dedicated radiotherapy trials quality assurance programme (RTQA), promoting the safe and effective delivery of HS intensity-modulated radiotherapy (IMRT) in a multicentre trial setting.Methods:Submitted planning benchmark cases were reviewed using visualization for radiotherapy software (VODCA) evaluating plan quality and compliance in relation to the HIPPO radiotherapy planning and delivery guidelines.Results:Comparison of the planning benchmark data highlighted a plan specified using dose to medium as an outlier by comparison with those specified using dose to water. Further evaluation identified that the reported plan statistics for dose to medium were lower as a result of the dose calculated at ...

Objective Calcium hydroxide (Ca(OH)2) has been used in endodontics as an intracanal medicament due to its antimicrobial effects and its ability to inactivate bacterial endotoxin. The inability to totally remove this intracanal medicament from the root canal system, however, may interfere with the setting of eugenol-based sealers or inhibit bonding of resin to dentin, thus presenting clinical challenges with endodontic treatment. This study used a chemical titration method to measure residual Ca(OH)2 left after different endodontic irrigation methods. Material and Methods Eighty-six human canine roots were prepared for obturation. Thirty teeth were filled with known but different amounts of Ca(OH)2 for 7 days, which were dissolved out and titrated to quantitate the residual Ca(OH)2 recovered from each root to produce a standard curve. Forty-eight of the remaining teeth were filled with equal amounts of Ca(OH)2 followed by gross Ca(OH)2 removal using hand files and randomized treatment of either: 1) Syringe irrigation; 2) Syringe irrigation with use of an apical file; 3) Syringe irrigation with added 30 s of passive ultrasonic irrigation (PUI), or 4) Syringe irrigation with apical file and PUI (n=12/group). Residual Ca(OH)2 was dissolved with glycerin and titrated to measure residual Ca(OH)2 left in the root. Results No method completely removed all residual Ca(OH)2. The addition of 30 s PUI with or without apical file use removed Ca(OH)2 significantly better than irrigation alone. Conclusions This technique allowed quantification of residual Ca(OH)2. The use of PUI (with or without apical file) resulted in significantly lower Ca(OH)2 residue compared to irrigation alone.

Human infection with Australian bat lyssavirus is extremely rare. Here we present the craniospinal findings in a fatal case of Australian bat lyssavirus infection in an 8-year-old child. MRI plays a very important role, not only in the diagnostic work-up of Australian bat lyssavirus infection but also in the prognostic assessment.

With an ever-increasing measurement of pupil and school performance and presence of resultant statistical tables and indicators, parents are faced with a sometimes overwhelming plethora of data and information when monitoring the performance of their children’s present or prospective school. The authors are part of a company that has developed a parent/carer-accessible site to attempt to address issues and needs for parents/carers. Anecdotal evidence indicates that a single portal where parent/carers can find all the relevant data about schools in England would be an invaluable tool for monitoring and choosing a school. It was decided that such a site would be built around a National Single Indicator (NSI). The indicator is formed from an amalgam of expected progress measures: the main threshold level; pupils’ average points score; and the value added measure. By changing the weight attributed to each of these measures, the website allows parents to modify their relative importance according to the value they place on them. This dynamically alters the overall result to give users their own “personal indicator”, which means they can compare schools in a list tailored to their own specification.

This paper describes the Low Storage Requirement (LSR) Hybrid Electric Vehicle configuration and discusses the advantages of this type of hybrid vehicle. A description of the LSR operating strategy and dynamic vehicle model are presented including simulation results.

Considers how far the aerospace industry has travelled on the long journey towards lean and agile manufacturing. Starts by comparing the industry with a well‐established model of a lean and in some cases agile manufacturing system already well established in the automotive manufacturing industry. Makes some attempts to overcome the difference in output volume of the two industries. Asks whether lean manufacturing can be applied to the aerospace industry. Draws on observations made both by academics and during visits to aerospace supply companies. Evidence is put forward as to deployment of lean practices in the industry and why lean manufacturing must be deployed throughout the industry. Focuses on the tentative steps towards the first phases of agile manufacturing, through Lean production, in an industry that produces a high technology leading‐edge product using outdated manufacturing systems.

The recent report on American students by the Brown Center on Education Policy is part of an assault on progressive education that attempts to misdirect our attention from what really matters in schools, Mr. Phillips argues. ********** OVER THE past few years, there has been a more or less continual assault on progressive education. Within the policy sphere, education has been dominated by the No Child Left Behind (NCLB) Act and its closely related state-level mandates. The focus has been on standards, test scores, and accountability. Within the education establishment, a number of supposedly authoritative, but critically flawed, research reports have appeared that have used test results as cover for thinly veiled attacks on progressive approaches. The most recent and insidious of these reports was brought to my attention by a headline in my local newspaper that read, "Happiness of Students Appears to Be Overrated." The story highlighted a recent study, How Well Are American Students Learning? by the Brookings Institution's Brown Center on Education Policy. While this is a major and respectable education think tank, the report it issued is an embarrassment. One major section of the report, "The Happiness Factor in Student Learning," deserves particular attention. The report describes contemporary "progressives" (using Bill Gates as the primary example!) as mistakenly abandoning book learning, subject-matter knowledge, and learning for learning's sake in favor of activity-based learning, learning how to learn, and learning for self-awareness and personal growth. Gates' praise for a project-focused, allegedly "no book and no lecture" school is cited as the prime evidence. Having created this straw man, How Well Are Our Students Learning? does its best to demolish it. The report totally disregards the fact that good contemporary progressive educators make extensive use of the written word, are well steeped in subject-matter knowledge, and integrate project-based learning, small-group instruction, and brief lectures in highly effective ways. The report is focused on international comparisons and shows that countries that rank lower in student happiness, confidence, and subject-matter relevance do better on the international math tests. Including student happiness as a major variable and using it as the eye-catching headline of a major section of the report suggests that the researchers were either extraordinarily limited in their thinking or purposefully manipulative. Measuring happiness through any single instrument or process is impossible; sophisticated researchers of this variable are just beginning to tease out all the complexities. But when we look closer at the Brown data, we find that the researchers never measured happiness at all. They measured enjoyment of mathematics, which is not the equivalent of student happiness. The use of the term happiness throughout the study is, at best, foolish and, at worst, misleading. Equally troublesome, the measure of enjoyment used is a response to a single item: "I enjoy mathematics." Apart from these extraordinarily flawed measurement devices, there is far more wrong with the assertion that student happiness doesn't matter and its implications. Of course student enjoyment is no guarantee of learning, and mistaken confidence can be counterproductive. This is now conventional wisdom that is shared by most educators, including progressive educators. But the study provides no insight into what does effectively enhance learning. Equally important, its use of cross-cultural data is flawed and misleading. Let's take Japan as one example. It's one of the primary countries cited for its high test scores in math and its low scores for student confidence and enjoyment of math. What a great example! In his highly praised new book, Shutting Out the Sun, Michael Zielenziger describes a generation of hundreds of thousands of young Japanese who "have retreated into their bedroom and refused to come out. …

We provide a linear time algorithm to solve the bottleneck traveling salesman problem on a Halin graph. This improves the O(n log n) time bound obtained by the binary search version of the threshold algorithm.