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Background: As the rate of opioid use in pregnancy escalates, there are a growing number of women diagnosed with opioid use disorder (OUD) and their newborns being cared for in inpatient settings., Purpose: In this study, we sought to better understand the experiences of nurses and nursing assistants working with women diagnosed with OUD and their newborns. By identifying the needs of nurses and nursing assistants, the findings from this study may contribute to reductions in stigma and improved patient care., Methods: Nurses and nursing assistants were recruited from a postpartum unit at a large urban hospital in Utah. Participants (n = 30) attended up to 4 semistructured focus groups. We utilized Braun and Clarke's 6-phase approach to thematic analysis to analyze transcribed interviews., Findings/results: Themes identified during the data analysis process included negative feelings and reactions toward patients; preferential concern for the newborn over maternal well-being; and identification of organizational and training needs to overcome these challenges., Implications for Practice: These findings identify strategies for addressing challenges faced by nurses and nursing assistants in caring for women diagnosed with OUD and their newborns., Implications for Research: Future research should examine the effectiveness of approaches to reduce behaviors influenced by stigma among nurses and nursing assistants working with women diagnosed with OUD and their newborns, as well as employee and patient satisfaction, and long-term health outcomes., Competing Interests: No conflicts of interest., (Copyright © 2020 by the National Association of Neonatal Nurses.)

Background and Aims: Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors., Methods: Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges., Results: The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5 th March) and the implementation of the Act-FAST campaign (6 th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23 rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here., Conclusion: Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID-19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Paroxysmal atrial fibrillation (PAF) is a frequent cause of recurrent stroke but can be difficult to detect because of its episodic and often asymptomatic nature. We sought to improve rate of PAF detection through a quality improvement project (QIP) to deliver early prolonged inpatient cardiac monitoring on the stroke unit (SU)., Methods: A structured protocol for cardiac monitoring using 5-day event recorders was established. 'In-house' cardiac monitoring was implemented. Performance data on this change in service was analysed prospectively and summary statistics obtained., Results: One-hundred and two ischaemic stroke (IS) patients undertook 5-day event recorder monitoring. Provision of monitors as an inpatient (IP) increased from 20% (pre-QIP pilot 2018) to 65.7% (during QIP). New AF was detected in 15 patients (14.7% vs 8.6% pre-QIP pilot 2018) with majority of new AF (13 patients; 19%) detected when monitors applied early (IP) after IS., Conclusion: Although this study had a number of limitations, it did demonstrate that early and prolonged non-invasive IP cardiac monitoring could be delivered 'in-house' on the SU and improve AF detection rates., (© Royal College of Physicians 2020. All rights reserved.)

A pandemic calls for large-scale action across national and international innovation systems in order to mobilize resources for developing and manufacturing crisis-critical products efficiently and in the huge quantities needed. Nowadays, these products also include a wide range of digital innovations. Given that many responses to the pandemic are technology driven, stakeholders involved in the development and manufacturing of crisis-critical products are likely to face intellectual property (IP)-related challenges. To (governmental) decision makers, IP challenges might not appear to be of paramount urgency compared to the many undoubtedly huge operational challenges to deploy critical resources. However, if IP challenges are considered too late, they may cause delays to urgently mobilize resources effectively. Innovation stakeholders could then be reluctant to fully engage in the development and manufacturing of crisis-critical products. This article adopts an IP and innovation perspective to learn from the currently unfolding COVID-19 pandemic using secondary data, including patent data, synthesized with an IP roadmap. We focus on technical aspects related to research, development, and upscaling of capacity to manufacture crisis-critical products in the huge volumes suddenly in demand. In this article, we offer a set of contributions. We provide a structure, framework, and language for those concerned with steering clear of IP challenges to avoid delays in fighting a pandemic. We provide a reasoning why IP needs to be considered earlier rather than too late in a global health crisis. Major stakeholders we identify include 1) governments; 2) manufacturing firms owning existing crisis-critical IP (incumbents in crisis-critical sectors); 3) manufacturing firms normally not producing crisis-critical products suddenly rushing into crisis-critical sectors to support the manufacturing of crisis-critical products in the quantities that far exceed incumbents' production capacities; and 4) voluntary grassroot initiatives that form during a pandemic, often by highly skilled engineers and scientists in order to contribute to the development and dissemination of crisis-critical products. For these major stakeholders, we draw up three scenarios, from which we identify associated IP challenges they face related to the development and manufacturing of technologies and products for 1) prevention (of spread); 2) diagnosis of infected patients; and 3) the development of treatments. This article provides a terminology to help policy and other decision makers to discuss IP considerations during pandemics. We propose a framework that visualizes changing industrial organizations and IP-associated challenges during a pandemic and derive initial principles to guide innovation and IP policy making during a pandemic. Obviously, our findings result only from observations of one ongoing pandemic and thus need to be verified further and interpreted with care.

Cone-beam CT-guided single dose of lung stereotactic body radiotherapy (SBRT) treatment with a flattening filter free (FFF) beam and volumetric modulated arc therapy (VMAT) is a safe and highly effective treatment modality for selective small lung lesions. Four-dimensional (4D) CT-based treatment plans were generated using advanced AcurosXB algorithm for heterogeneity corrections. 6X-FFF beam produced highly conformal radiosurgical dose distribution to the target and reduced lung SBRT fraction duration to less than 10 min for a single dose of 30 Gy, significantly improving patient comfort and clinic workflow. Early follow-up CT imaging results (mean, 8 months) show high local control rates (100%) with no acute lung or rib toxicity. Longer clinical follow-up in a larger patient cohort managed in this fashion is underway to further validate this treatment approach., (© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

In mice, the maternal microbiome influences fetal immune development and postnatal allergic outcomes. Westernized populations have high rates of allergic disease and low rates of gastrointestinal carriage of Prevotella, a commensal bacterial genus that produces short chain fatty acids and endotoxins, each of which may promote the development of fetal immune tolerance. In this study, we use a prebirth cohort (n = 1064 mothers) to conduct a nested case-cohort study comparing 58 mothers of babies with clinically proven food IgE mediated food allergy with 258 randomly selected mothers. Analysis of the V4 region of the 16S rRNA gene in fecal samples shows maternal carriage of Prevotella copri during pregnancy strongly predicts the absence of food allergy in the offspring. This association was confirmed using targeted qPCR and was independent of infant carriage of P. copri. Larger household size, which is a well-established protective factor for allergic disease, strongly predicts maternal carriage of P. copri.

Background: High folate status in pregnancy has been implicated in the increased prevalence of allergic disease, but there are no published data relating directly measured folate status in pregnancy to challenge-proven food allergy among offspring. The study aim was to examine the association between red blood cell (RBC) folate status in trimester three of pregnancy and allergic disease among offspring., Methods: Red blood cell folate levels were measured at 28-32 weeks' gestation in a prospective birth cohort (n = 1074). Food allergy outcomes were assessed in 1-year-old infants by skin prick testing and subsequent food challenge. Eczema was assessed by questionnaire and clinical review. High trimester three RBC folate was defined as greater than (>) 1360 nmol/L. Binomial regression was used to examine associations between trimester three RBC folate and allergic outcomes, adjusting for potential confounders., Results: Red blood cell folate levels were measured in 88% (894/1064) of pregnant women. The mean concentration was 1695.6 nmol/L (standard deviation 415.4) with 82% (731/894) >1360 nmol/L. There was no evidence of either linear or non-linear relationships between trimester three RBC folate and allergic outcomes, nor evidence of associations between high RBC folate and food allergy (adjusted risk ratio (aRR) 2.89, 95% CI 0.90-9.35), food sensitization (aRR 1.72, 95% CI 0.85-3.49), or eczema (aRR 0.97, 95% CI 0.67-1.38)., Conclusion: The majority of pregnant women in this study had high RBC folate levels. There was no evidence of associations between trimester three RBC folate and food allergy, food sensitization, or eczema among the offspring, although larger studies are required., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Many real-world applications require artificial agents to compete and coordinate with other agents in complex environments. As a stepping stone to this goal, the domain of StarCraft has emerged as an important challenge for artificial intelligence research, owing to its iconic and enduring status among the most difficult professional esports and its relevance to the real world in terms of its raw complexity and multi-agent challenges. Over the course of a decade and numerous competitions 1-3 , the strongest agents have simplified important aspects of the game, utilized superhuman capabilities, or employed hand-crafted sub-systems 4 . Despite these advantages, no previous agent has come close to matching the overall skill of top StarCraft players. We chose to address the challenge of StarCraft using general-purpose learning methods that are in principle applicable to other complex domains: a multi-agent reinforcement learning algorithm that uses data from both human and agent games within a diverse league of continually adapting strategies and counter-strategies, each represented by deep neural networks 5,6 . We evaluated our agent, AlphaStar, in the full game of StarCraft II, through a series of online games against human players. AlphaStar was rated at Grandmaster level for all three StarCraft races and above 99.8% of officially ranked human players.

Background: There is a growing body of evidence that speech and language therapy (SLT) intervention is effective in improving communication ability for individuals with non-progressive acquired apraxia of speech (AOS). However, there is no universally agreed diagnostic standard for AOS, and diverging opinions on its diagnostic features. This has led to claims that diverse diagnostic criteria may be used to select participants for AOS research studies. These claims raise concerns for evidence-based practice in AOS but have yet to be systematically investigated., Aims: To determine the presence, nature and extent of diversity in the diagnostic criteria for non-progressive AOS used in both published studies and clinical practice internationally., Methods & Procedures: The study used a scoping review methodology that followed the 2005 framework of Arksey and O'Malley and included a consultation exercise in the form of an online survey of international SLTs. The scoping review included 157 studies involving participants with acquired AOS, published between 1997 and 2017. There were 264 respondents to the online survey of SLTs, with a completion rate of 72%. Respondents came from 15 countries and had varying levels of clinical experience., Main Contribution: This study found that no common set of diagnostic criteria for AOS was used universally across research and practice. Although the diagnostic criteria used to select participants with AOS were reported explicitly in most studies, they varied from study to study. Some studies used directly conflicting criteria. Use of specific diagnostic criteria in studies was influenced by year of publication but not by location. There was a trend towards increasing consistency in diagnostic criteria in recent years. Compared with the research, the survey revealed relatively greater consistency among SLTs on the speech features considered indicative of AOS, although the SLTs who responded to the survey showed variation in how diagnostic criteria were combined into sets. Use of specific diagnostic criteria was not associated with SLTs' location or experience. There were differences between the diagnostic criteria for AOS used most commonly in research studies and those selected most commonly by SLTs in the survey. These findings have implications for the generalizability of AOS research to clinical practice, as well as implications for effective research synthesis., Conclusions & Implications: The claim that research and practice in the field of AOS is characterized by the use of diverse diagnostic criteria is supported by this scoping review. The findings support the need to develop a universal consensus standard for AOS diagnosis to ensure consistency across research and clinical practice., (© 2019 Royal College of Speech and Language Therapists.)

Background: In previous studies, deficits in regulatory T-cell (Treg) number and function at birth have been linked with subsequent allergic disease. However, longitudinal studies that account for relevant perinatal factors are required. The aim of this study was to investigate the relationship between perinatal factors, naïve Treg (nTreg) over the first postnatal year and development of food allergy., Methods: In a birth cohort (n = 1074), the proportion of nTreg in the CD4 + T-cell compartment was measured by flow cytometry at birth (n = 463), 6 (n = 600) and 12 (n = 675) months. IgE-mediated food allergy was determined by food challenge at 1 year. Associations between perinatal factors (gestation, labour, sex, birth size), nTreg at each time point and food allergy at 1 year were examined by linear regression., Results: A higher proportion of nTreg at birth, larger birth size and male sex was each associated with higher nTreg in infancy. Exposure to labour, as compared to delivery by prelabour Caesarean section, was associated with a transient decrease nTreg. Infants that developed food allergy had decreased nTreg at birth, and the labour-associated decrease in nTreg at birth was more evident among infants with subsequent food allergy. Mode of birth was not associated with risk of food allergy, and there was no evidence that nTreg at either 6 or 12 months were related to food allergy., Conclusion: The proportion of nTreg at birth is a major determinant of the proportion present throughout infancy, highlighting the importance of prenatal immune development. Exposure to the inflammatory stimulus of labour appears to reveal differences in immune function among infants at risk of food allergy., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Purpose: The CivaSheet device uses multiple directionally shielded Pd-103 CivaDot sources to produce a directional planar dose distribution. In postplanning, manually digitizing the 3D source orientation is challenging because the 3D vector must be digitized by using 2D displayed images. The aim of this study is to develop an algorithm that will automatically determine the direction of each CivaDot source based on the location of sources adjacent to it., Methods and Materials: The algorithm determines the source direction by averaging the normal directions of multiple local planes established by the adjacent sources. The algorithm was tested on a manually constructed CivaSheet-like device that was CT scanned in known flat geometries and two known curved geometries. Algorithmically determined source directions were compared with the known directions. The algorithm was also used on a postplan for a gynecological pelvic sidewall tumor bed implant and compared against manual digitization of the source directions., Results: For the flat and curved test geometries, the average angular difference between the algorithm determined and known orientation was 1.2° ± 0.8° (flat geometry), 1.7° ± 2.1° (curve about vertical axis), and 2.3° ± 2.4° (curve about horizontal axis). For the patient case, results showed on average a 23.1° ± 10.8° difference between the manual digitized orientation and the algorithm's predicted orientation., Conclusions: The algorithm calculates the source orientation with accuracy better than 2.3° for the controlled experiments. In addition to its accuracy, the algorithm produces consistent results and lessens the difficult challenge of orienting the partially shielded sources., (Copyright © 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to describe mid- to long-term outcomes of anterior cruciate ligament (ACL) reconstruction with simultaneous or staged medial unicompartmental knee replacement (UKR), and compare outcomes between (1) young patients aged younger than 55 at surgery and those older, (2) those with long-term follow-up greater than 10 years, (3) cemented and cementless UKR, and (4) compare outcomes to those with an intact ACL., Patients and Methods: We identified knees with staged or simultaneous ACL reconstruction and medial UKR from a prospectively followed designer UKR cohort, and describe mean Oxford Knee Score (OKS), mean Tegner activity score and Kaplan-Meier survival estimates. We matched these knees to ACL-intact knees., Results: Seventy-six consecutive UKR with staged or simultaneous ACL reconstruction were identified with mean six-year follow-up (range 1-15). There was significant improvement in OKS and Tegner score with surgery. At most recent follow-up, OKS was 41.0 (range 11 to 48), and Tegner score 3.6 (0 to 8). There were three revisions occurring at a mean of five years post-operatively. The five-, 10- and 15-year survival estimates were 97% (95% confidence interval [CI] 93-100), 92% (83-100), and 92% (83-100). There was no difference in functional scores or implant survival in young patients, those with long-term follow-up (>10 years), those with cementless fixation, or when compared to ACL intact knees., Conclusion: These results demonstrate excellent mid- to long-term function and survival of selected patients who have undergone ACL reconstruction and medial UKR. Their outcome was similar to those with intact ACLs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: Some health providers ration knee arthroplasty on the basis of body mass index (BMI). There is no long-term data on the outcome of medial mobile-bearing unicompartmental knee arthroplasty (UKA) in different BMI groups. This study aimed to determine the effect of patient body mass index (BMI) on patient-reported outcomes and long-term survival of medial UKA in a large non-registry cohort. Our hypothesis is that increasing BMI would be associated with worse outcomes., Methods: Data were analysed from a prospective cohort of 1000 consecutive medial mobile-bearing Oxford UKA with mean 10-year follow-up. Patients were grouped: BMI < 25, BMI 25 to < 30, BMI 30 to < 35 and BMI 35+. Oxford Knee Score (OKS) and Tegner Activity Score were assessed at 1, 5 and 10 years. Kaplan-Meier survivorship was calculated and compared between BMI groups., Results: All groups had significant improvement in OKS and Tegner scores. BMI 35 + kg/m 2 experienced the greatest overall increase in mean OKS of 17.3 points (p = 0.02). There was no significant difference in ten-year survival, which was, from lowest BMI group to highest 92%, 95%, 94% and 93%., Conclusion: There was no difference in implant survival between groups, and although there was no consistent trend in postoperative OKS, the BMI 35+ group benefited the most from UKA. Therefore, when UKA is used for appropriate indications, high BMI should not be considered to be a contraindication. Furthermore rationing based on BMI seems unjustified, particularly when the commonest threshold (BMI 35) is used., Level of Evidence: III.

Purpose/objectives: Due to higher radiosensitivity, non-target normal tissue dose is a major concern in stereotactic body radiation therapy (SBRT) treatment. The aim of this report was to estimate the dosimetric impact, specifically the reduction of normal lung dose in the treatment of single-isocenter/two-lesion lung SBRT via volumetric modulated arc therapy with jaw tracking (JT-VMAT)., Materials/methods: Twelve patients with two peripherally located early-stage non-small-cell-lung cancer (NSCLC) lung lesions underwent single-isocenter highly conformal non-coplanar JT-VMAT SBRT treatment in our institution. The mean isocenter to tumors distance was 5.6 ± 1.9 (range 4.3-9.5) cm. The mean combined planning target volume (PTV) was 38.7 ± 22.7 (range 5.0-80.9) cc. A single isocenter was placed between the two lesions. Doses were 54 and 50 Gy in three and five fractions, respectively. Plans were optimized in Eclipse with AcurosXB algorithm utilizing jaw tracking options for the Truebeam with a 6 MV-FFF beam and standard 120 leaf millennium multi-leaf collimators. For comparison, the JT-VMAT plans were retrospectively re-computed utilizing identical beam geometry, objectives, and planning parameters, but without jaw tracking (no JT-VMAT). Both plans were normalized to receive the same target coverage. The conformity and heterogeneity indices, intermediate-dose spillage [D 2cm , R50, Gradient Index (GI), Gradient Distance (GD)], organs at risks (OAR) doses including normal lung as well as modulation factor (MF) were compared for both plans., Results: For similar target coverage, GI, R50, GD, as well as the normal lung V5, V10, V20, mean lung dose (MLD), and maximum dose received by 1000 cc of lungs were statistically significant. Normal lung doses were reduced by 8%-11% with JT-VMAT. Normal lung dose increased as a function of tumor distance from isocenter. For the other OAR, up to 1%-16% reduction of non-target doses were observed with JT-VMAT. The MF and beam-on time were similar for both plans, however, MF increased as a function of tumors distance, consequently, delivering higher dose to normal lungs., Conclusion: Utilizing jaw tracking options during optimization for single-isocenter/two-lesion lung SBRT VMAT plans reduced doses to the normal lung and other OAR, reduced intermediate-dose spillage and provided superior/similar target coverage. Application of jaw tracking did not affect delivery efficiency and provided excellent plan quality with similar MF and beam-on time. Jaw tracking is recommended for future clinical SBRT plan optimization., (© 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Comyns, TM, Brady, CJ, and Molloy, J. Effect of attentional focus strategies on the biomechanical performance of the drop jump. J Strength Cond Res 33(3): 626-632, 2019-Motor performance can be influenced by focusing an athlete's attention through the use of verbal instructions. There is limited research on the effect of internal, neutral, and external attentional focus strategies on drop jump (DJ) performance aimed at maximizing height jumped (HJ) and minimizing ground contact time (CT). The purpose of this study was to assess the effect of attentional focus strategies on biomechanical variables related to efficient DJ performance, namely HJ, CT, reactive strength index (RSI), leg-spring stiffness, and peak and relative peak ground reaction force (GRF). Seventeen male recreationally trained subjects performed 2 DJs after listening to instructions designed to evoke an internal, external, or neutral attentional focus. In total, 6 DJs were performed in the testing session, and the order of the instructions was randomly assigned. Significance was set at p ≤ 0.05. Results indicated that, compared with the neutral strategy, the external focus resulted in significantly higher RSI (p = 0.046), peak GRF (p = 0.025), relative GRF (p = 0.02), and leg-spring stiffness (p = 0.02). No significant difference was seen in DJ CT and HJ between all 3 conditions (p ≥ 0.05). These results indicate that the use of an external focus of attention may potentially result in a more effective and efficient fast stretch-shortening cycle performance because of the augmentation of RSI and leg stiffness. More research is warranted, however, because of the lack of significant results pertaining to CT and HJ.

The orthovoltage x-ray energy frequently used in radiation research is prone to dosimetry errors due to insufficient backscatter conditions. In many radiobiology studies, especially for cell irradiations, precise dose calculation algorithms such as Convolution-Superposition or Monte Carlo are impractical and as such, less accurate hand calculation methods are used for dose estimation. These dose estimation methods typically assume full backscatter conditions. The purpose of this study is to demonstrate the magnitude of the dose error that results from insufficient backscatter, and to provide lookup tables to account this issue. The beam spectra of several widely used commercial systems (XRAD-225, XRAD-320, SARRP) were used in Monte Carlo (MC) simulations on a series of phantom setups to investigate the impact of varying backscatter conditions on dosimetry. The depth dose curves for different field sizes, water phantom thicknesses and beam qualities were generated. In addition, depth dependent backscatter factors for different field sizes and different beam qualities were calculated. It is demonstrated that as much as a 50% dose difference exists for different backscatter conditions at the beam qualities studied. The choice of cell dish size as well as other changes in the experiment setup can have more than 10% impact on the dose. The impact of backscatter is reduced with a decrease in field size. Further, the thickness needed to provide full backscatter can be approximated as being equal to the field size. It is imperative to ensure full backscatter conditions during system and dosimeter calibration, or to use the look-up table provided in this study.

Background: There is controversy about optimal limb alignment following knee replacement. An aim of using Oxford medial unicompartmental knee replacement (UKR) implants is to accurately restore normal ligament tension in the knee, thereby restoring normal kinematics. This return to normal tension typically results in a return to prearthritic alignment, which is frequently varus. The aim of this study was to investigate the relationship between postoperative limb alignment and postoperative patient-reported outcome and implant revision rate., Methods: We used a consecutive cohort of 891 knees with cemented Oxford medial UKR implants with a mean 10-year follow-up and recorded alignment. We grouped knees according to postoperative mechanical alignment as marked varus (estimated at 10°), mild varus (estimated at 5°), neutral, and valgus. The mean Oxford Knee Score (OKS) was calculated at 5 and 10 years postoperatively. Revision risk was assessed by survival analysis and component-time incidence rates., Results: Postoperatively, 67 (8%) of the 891 knees were in marked varus; 308 (35%), in mild varus; 508 (57%), in neutral; and 8 (1%), in valgus. The valgus group (8 knees) was too small for further analysis. The mean OKS (and standard deviation [SD]) at 10 years postoperatively was 41.7 ± 7 for marked varus, 40.5 ± 8 for mild varus, and 39.4 ± 9 for neutral alignment (p = 0.28). At 10 years, 92%, 85%, and 76% achieved a good or excellent OKS outcome, respectively (p = 0.02). Twelve-year survival rates were 93.3% for marked varus, 93.2% for mild varus, and 93.6% for neutral alignment, respectively (p = 0.53). Revision incidence rates per 100 component-years were 0.49 (95% confidence interval [CI], 0.2 to 1.5), 0.36 (95% CI, 0.2 to 0.7), and 0.54 (95% CI, 0.4 to 0.8), respectively, and were not significantly different (p = 0.53)., Conclusions: Marked postoperative varus mechanical alignment of an estimated 10° was present in 8%, and mild varus of about 5° was present in 35%. Increasing varus alignment was associated with an increasing percentage of good or excellent OKS outcomes, but otherwise there were no significant differences between alignment groups in patient-reported outcome or revision rate. These data support the standard operative technique for the Oxford UKR, which aims to restore ligament tension and therefore prearthritic alignment rather than neutral mechanical alignment., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Few-layer graphene (FLG) platelets exfoliated directly from graphite are finding a wide range of potential applications, including composites and printed electronics. However, characterisation of the FLG material following incorporation into polymers, including the quality of the dispersion, remains a challenge. Here, we present the use of terahertz time-domain spectroscopy as a potential solution to this challenge which could form the basis of a rapid characterisation tool. The THz refractive index was found to be highly sensitive to the loading of FLG, opening the route to mapping local FLG concentration within a polymer composite sample. By fitting the measured permittivity of the flakes to the Drude-Smith model of conductivity, we also show that the carrier concentrations of these materials are comparable to un-doped chemical vapour deposition produced materials. The ability to measure electronic properties of FLG following processing is important to ensure that defects have not been introduced or chemical functionalisation removed during processing.

Purpose/objectives: To evaluate the plan quality and treatment delivery efficiency of single-isocenter/two-lesions volumetric modulated arc therapy (VMAT) lung stereotactic body radiation therapy (SBRT)., Materials/methods: Eight consecutive patients with two peripherally located early stage nonsmall-cell-lung cancer (NSCLC) lung lesions underwent single-isocenter highly conformal noncoplanar VMAT SBRT treatment in our institution. A single-isocenter was placed between the two lesions. Doses were 54 or 50 Gy in 3 and 5 fractions respectively. Patients were treated every other day. Plans were calculated in Eclipse with AcurosXB algorithm and normalized to at least 95% of the planning target volume (PTV) receiving 100% of the prescribed dose. For comparison, two-isocenter plans (isocenter placed centrally in each target) were retrospectively created. Conformity indices (CIs), heterogeneity index (HI), gradient index (GI), gradient distance (GD), and D 2cm were calculated. The normal lung V5, V10, V20, mean lung dose (MLD) and other organs at risk (OARs) doses were evaluated. Total number of monitor units (MUs), beam-on time, and patient-specific quality assurance (QA) results were recorded., Results: The mean isocenter to tumor distance was 6.7 ± 2.3 cm. The mean combined PTV was 44.0 ± 23.4 cc. There was no clinically significant difference in CI, HI, GD, GI, D 2cm , and V20 including most of the OARs between single-isocenter and two-isocenter lung SBRT plans, evaluated per RTOG guidelines. However, for single-isocenter plans as the distance between the lesions increased, the V5, V10, and MLD increased, marginally. The total number of MUs and beam-on time was reduced by a factor of 1.5 for a single-isocenter plan compared to a two-isocenter plan. The single-isocenter/two-lesions VMAT lung SBRT QA plans demonstrated an accurate dose delivery of 98.1 ± 3.2% for clinical gamma passing rate of 3%/3 mm., Conclusion: The SBRT treatment of two peripherally located lung lesions with a centrally placed single-isocenter was dosimetrically equivalent to two-isocenter plans. Faster treatment delivery for single-isocenter treatment can improve patient compliance and reduce the amount of intrafraction motion errors for well-suited patients., (© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Objectives: This is the first nationwide analysis of food marketing around New Zealand (NZ) schools., Methods: Zones (500-m network buffers) were created around a sample of 950 schools (37.5% of total) using ArcGIS. Foods advertised were classified according to the NZ Food and Beverage Classification System and the World Health Organization (WHO) Europe Nutrient Profile Model. Convenience, fast food and takeaway outlets were mapped., Results: About 65% of foods were not permitted to be marketed to children by the WHO model. The median and maximum number of non-permitted foods was 16.2 per km 2 and 805.9 per km 2 , and the median number of junk food advertisements was 10.6 per km 2 for urban schools. The proportion of junk food advertisements was significantly higher around schools with the highest (50.7% vs. 37.4%, p < 0.001) compared to the lowest number of socio-economically deprived children. Sugar-sweetened beverages (N = 4584, 20.4%) and fast food (N = 4329, 19.2%) were most frequently marketed. The median and maximum number of unhealthy outlets around schools was 5 and 212, respectively., Conclusions: NZ schools are surrounded by unhealthy food marketing. Regulations to restrict such marketing need to be implemented.

Background/objectives: The retail environment is a key setting for potential public health interventions. This study assessed the healthiness of New Zealand supermarket food environments., Subject/methods: A sample of 204 (about 50% of national total) supermarkets across three chains was selected in 2016, half in the most deprived socioeconomic areas. Healthiness indicators related to food availability (ratio of cumulative linear shelf length for healthy versus unhealthy foods), prominence (proportion of 'junk food free' check-outs and end-of-aisle endcaps), and promotion (proportion of 'junk food free' promotions in flyers and in-store) were measured., Results: About 26.5% of supermarkets had at least 20% of check-outs junk-food-free and 17.2% had at least 60% of endcaps junk food free. On average 2/3 of food promotions in-store and ¾ of food promotions in flyers were junk food free. For every 1 m of shelf length for unhealthy foods, there was 42 cm of shelf length for healthy foods on average, with large variations between and within stores. In high and low prominence store areas there was on average 1 m of unhealthy foods for every 2 cm of healthy foods and 1 m of unhealthy foods for every 4 m of healthy foods, respectively. The shelf length ratio was significantly lower in the most compared to the least/medium deprived socioeconomic areas (p = 0.003)., Conclusions: The large variations in healthiness indicators within and across chains present a great opportunity for retailers to improve the healthiness of supermarkets towards best practice.

Background: The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient deterioration. To date, there have been few studies which have explored the relationship between time of day of RRC and patient outcome., Objective: To examine the relationship between the time of RRC activations and patient outcome., Method: All adult inpatients with a RRC in non-critical care wards of a metropolitan Australian hospital in 2012 were retrospectively reviewed. RRCs occurring between 18:00-07:59 were defined as 'out of hours'., Results: There were 892 RRC during the study period. RRCs out of hours were associated with a higher rate of ICU admissions immediately after the RRC (19.4% vs. 12.3%, p<0.001). Patients experiencing an out-of-hours RRC were more likely to have an in-hospital cardiopulmonary arrest (OR=1.7, p<0.04). In-hospital mortality rate was significantly higher for patients with out-of-hours RRCs (35.5% vs. 25.0%, p=0.014). After adjusting for confounders out-of-hours RRC were independently associated with increased need for ICU admissions and in-hospital mortality., Conclusion: The diurnal timing of RRCs appears to have significant implications for patient mortality and morbidity, patient outcomes are worse if RRC occurs out of hours. This finding has implications for staffing and resource allocation., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Background: Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy., Objective: To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year., Methods: In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D 3 (25(OH)D 3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D 3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding., Results: Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year., Conclusions: There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The reversible oxidation of coordinated phenolates into phenoxyl radicals results in a dramatic quenching (>95%) of the luminescence of the f metal ion.

Optical properties of 4H-SiC were measured using time-domain and Fourier transform spectroscopy in the range of 0.1-20 THz. A high-transparency region was found between <0.1-10 THz. Based on the obtained data and published results, the refractive indices for o-wave and e-wave were approximated in the form of Sellmeier equations for the entire transparency range. Phase matched frequency conversion was found to be possible at wavelengths from the visible through the mid-IR and further into the far-IR (THz) region beyond 17 μm. Extremely low absorption coefficient, high damage threshold, and the possibility of phase matching make this material highly suited for high power THz optics and generation.

The modern environment is associated with an increasing burden of non-communicable diseases (NCDs). Mounting evidence implicates environmental exposures, experienced early in life (including in utero), in the aetiology of many NCDs, though the cellular/molecular mechanism(s) underlying this elevated risk across the life course remain unclear. Epigenetic variation has emerged as a candidate mediator of such effects. The Barwon Infant Study (BIS) is a population-derived birth cohort study (n = 1074 infants) with antenatal recruitment, conducted in the south-east of Australia (Victoria). BIS has been designed to facilitate a detailed mechanistic investigation of development within an epidemiological framework. The broad objectives are to investigate the role of specific environmental factors, gut microbiota and epigenetic variation in early-life development, and subsequent immune, allergic, cardiovascular, respiratory and neurodevelopmental outcomes. Participants have been reviewed at birth and at 1, 6, 9 and 12 months, with 2- and 4-year reviews under way. Biological samples and measures include: maternal blood, faeces and urine during pregnancy; infant urine, faeces and blood at regular intervals during the first 4 years; lung function at 1 month and 4 years; cardiovascular assessment at 1 month and 4 years; skin-prick allergy testing and food challenge at 1 year; and neurodevelopmental assessment at 9 months, 2 and 4 years. Data access enquiries can be made at [www.barwoninfantstudy.org.au] or via [peter.vuillermin@deakin.edu.au]., (© The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Understanding the heterogeneity of groups along the vaccine hesitancy continuum presents an opportunity to tailor and increase the impact of public engagement efforts with these groups. Audience segmentation can support these goals, as demonstrated here in the context of the 2009 H1N1 vaccine. In March 2010, we surveyed 1569 respondents, drawn from a nationally representative sample of American adults, with oversampling of racial/ethnic minorities and persons living below the United States Federal Poverty Level. Guided by the Structural Influence Model, we assessed knowledge, attitudes, and behaviors related to H1N1; communication outcomes; and social determinants. Among those who did not receive the vaccine (n = 1166), cluster analysis identified three vaccine-hesitant subgroups. Disengaged Skeptics (67%) were furthest from vaccine acceptance, with low levels of concern and engagement. The Informed Unconvinced (19%) were sophisticated consumers of media and health information who may not have been reached with information to motivate vaccination. The Open to Persuasion cluster (14%) had the highest levels of concern and motivation and may have required engagement about vaccination broadly. There were significant sociodemographic differences between groups. This analysis highlights the potential to use segmentation techniques to identify subgroups on the vaccine hesitancy continuum and tailor public engagement efforts accordingly.

Background: Orolingual angio-oedema is a recognised complication of tissue plasminogen activator (tPA) for ischaemic stroke. We investigated its incidence, clinical characteristics and relationship with other factors in patients receiving tPA at a UK centre., Methods: 530 consecutive patients (median age 70 years) receiving tPA treatment for confirmed ischaemic stroke were included. Cases were defined as those developing angio-oedema within 24 h of initiation of tPA. Angio-oedema was retrospectively classified as mild, moderate or severe using predefined criteria. The primary analysis was the association between prior ACE inhibitor (ACE-I) treatment and angio-oedema., Results: Orolingual angio-oedema was observed in 42 patients (7.9%; 95% CI 5.5% to 10.6%), ranging from 5 to 189 min after initiation of tPA (median 65 min). 12% of the angio-oedema cases were severe (1% of all patients treated with tPA), requiring urgent advanced airway management. 172 patients (33%) were taking ACE-I. In multifactorial analyses, only prior ACE-I treatment remained a significant independent predictor of angio-oedema (odds ratio (OR) 2.3; 95% CI 1.1 to 4.7)., Conclusions: Angio-oedema occurs more frequently than previously reported and is associated with preceding ACE-I treatment. Angio-oedema may be delayed and progress to life-threatening airway compromise, which has implications for the assessment and delivery of thrombolysis., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: CT simulation data in image-guided radiation therapy (IGRT) provides patient-specific subject contrast. This information can be exploited to establish, a priori, a suitable imaging goal and to select patient-specific imaging acquisition parameters that optimize the similarity between reference and daily set-up images and reduce imaging dose. This study aims to describe and clinically validate a computerized algorithm designed to provide such optimization., Material and Methods: An image planning system (IPS) was developed to assist in planar kV imaging technique selection for radiation therapy. The system's patient-specific image quality and dose reduction capabilities were validated herein. Anthropomorphic phantom and clinical data were acquired. Mutual information (MI) was used to compare simulated and measured images in both phantom and clinical tests. Variations in contrast resolution resulting from imaging panel underexposure, saturation and a contrast plateau were investigated. For evaluation of patient-specific imaging dose reduction, the IPS was used to modify acquisition settings for six patients., Results: Phantom data confirmed the IPS's predictive capability regarding image contrast. Measured and simulated images showed similar progressions from under-exposure, image quality peak, and loss of contrast due to detector saturation. Clinical data demonstrated that contrast resolution and imaging dose could be prospectively improved without loss of image contrast. The algorithm reduced imaging dose by an average of 47%, and a maximum of 80%., Conclusions: Loss of image contrast resulting from under-exposure or over-exposure, as well as a contrast plateau can be predicted by use of a prospective image planning algorithm. Image acquisition parameters can be predicted that reduce patient dose without loss of useful contrast., (Copyright © 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature., Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants., Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program., Participants: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants., Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants., Ethical Considerations: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis., Results: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses' perceived lack of power and influence in the neonatal resuscitation decision-making process., Conclusion: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration., (© The Author(s) 2014.)

Studies from several countries have reported an association between latitudes further from the equator and proxy markers of food allergy prevalence. As latitudes further from the equator are associated with lower sun exposure and vitamin D status (VDS), it has been proposed that low VDS may be a risk factor for food allergy. A range of basic science evidence supports the biological plausibility of this hypothesis; and recent work has identified a cross sectional association between low VDS and challenge proven food allergy in infants. Overall, however, the evidence regarding the relationship between VDS and food allergy remains controversial and the limited longitudinal data are discouraging. In this review we consider the evidence for and against low VDS as a risk factor for food allergy and discuss the possibility that other factors (including genetic variables) may contribute to the inconsistent nature of the available observational evidence. We then discuss whether genetic and/or environmental factors may modify the potential influence of VDS on food allergy risk. Finally, we argue that given the rising burden of food allergy, the balance of available evidence regarding the potential relevance of VDS to this phenomenon, and the inherent limitations of the existing observational data, there is a compelling case for conducting randomised clinical trials of vitamin D supplementation for the prevention of food allergy during early life.

One of the foundations of the scientific method is to be able to reproduce experiments and corroborate the results of research that has been done before. However, with the increasing complexities of new technologies and techniques, coupled with the specialisation of experiments, reproducing research findings has become a growing challenge. Clearly, scientific methods must be conveyed succinctly, and with clarity and rigour, in order for research to be reproducible. Here, we propose steps to help increase the transparency of the scientific method and the reproducibility of research results: specifically, we introduce a peer-review oath and accompanying manifesto. These have been designed to offer guidelines to enable reviewers (with the minimum friction or bias) to follow and apply open science principles, and support the ideas of transparency, reproducibility and ultimately greater societal impact. Introducing the oath and manifesto at the stage of peer review will help to check that the research being published includes everything that other researchers would need to successfully repeat the work. Peer review is the lynchpin of the publishing system: encouraging the community to consciously (and conscientiously) uphold these principles should help to improve published papers, increase confidence in the reproducibility of the work and, ultimately, provide strategic benefits to authors and their institutions. Future incarnations of the various national Research Excellence Frameworks (REFs) will evolve away from simple citations towards measurable societal value and impact. The proposed manifesto aspires to facilitate this goal by making transparency, reproducibility and citizen-scientist engagement (with the knowledge-creation and dissemination processes) the default parameters for performing sound research.

One of the foundations of the scientific method is to be able to reproduce experiments and corroborate the results of research that has been done before. However, with the increasing complexities of new technologies and techniques, coupled with the specialisation of experiments, reproducing research findings has become a growing challenge. Clearly, scientific methods must be conveyed succinctly, and with clarity and rigour, in order for research to be reproducible. Here, we propose steps to help increase the transparency of the scientific method and the reproducibility of research results: specifically, we introduce a peer-review oath and accompanying manifesto. These have been designed to offer guidelines to enable reviewers (with the minimum friction or bias) to follow and apply open science principles, and support the ideas of transparency, reproducibility and ultimately greater societal impact. Introducing the oath and manifesto at the stage of peer review will help to check that the research being published includes everything that other researchers would need to successfully repeat the work. Peer review is the lynchpin of the publishing system: encouraging the community to consciously (and conscientiously) uphold these principles should help to improve published papers, increase confidence in the reproducibility of the work and, ultimately, provide strategic benefits to authors and their institutions.

Following the initial observation that methyl methanesulphonate induced binucleated cells in the AHH-1 line and a significant number of them contained micronuclei, human lymphoblastoid TK6 and mouse lymphoma L5178Y cells were treated with methyl methanesulphonate, methylnitrosourea, mitomycin C, cytosine arabinoside, colchicine and triton X. All except triton X induced binucleated cells in both lines but an increased micronucleus incidence in them was seen only in TK6. The two lines also differed in the numbers of binucleates in the control cultures with 2.0% and 0.5% in TK6 and L5178Y, respectively, and a much higher proportion of those in TK6 contained micronuclei. The differences in behaviour between the two cell lines could not clearly be ascribed to their P53 status. Colchicine induced binucleates in both cell lines but they did not contain increased numbers of micronuclei. The effect on binucleate incidence was not a non-specific cytotoxic response because no increase was seen with triton X even at highly cytotoxic concentrations. The initial concern that not scoring micronuclei in binucleated cells might lead to erroneous results in in vitro micronucleus tests not using a cytokinesis block, was not proven because all the genotoxins tested here induced significant increases in micronucleus frequency in mononuclear cells. When testing less potently active agents in in vitro micronucleus tests not employing a cytokinesis block, care should be taken to understand better this phenomenon and not to include these damaged cells until we do., (Copyright © 2014. Published by Elsevier B.V.)

A remediation program was implemented during the semester break in an associate degree nursing program to increase the pass rate on the NCLEX-RN of at-risk students in a targeted medical-surgical nursing course. Through the use of a course management system and an adaptive quizzing program, participants were facilitated to take a more active role in their learning. Faculty mentored students and witnessed a transformation in participants through graduation. Ultimately, success of these at-risk students in passing the NCLEX-RN helped maintain this nursing program's pass rate.

Purpose: The current widely used biological equivalent dose (BED) formalism for permanent implants is based on the linear-quadratic model that includes cell repair and repopulation but not resensitization (redistribution and reoxygenation). The authors propose a BED formalism that includes all the four biological effects (4Rs), and the authors propose how it can be used to calculate appropriate prescription doses for permanent implants with Cs-131., Methods: A resensitization correction was added to the BED calculation for permanent implants to account for 4Rs. Using the same BED, the prescription doses with Au-198, I-125, and Pd-103 were converted to the isoeffective Cs-131 prescription doses. The conversion factor F, ratio of the Cs-131 dose to the equivalent dose with the other reference isotope (Fr: with resensitization, Fn: without resensitization), was thus derived and used for actual prescription. Different values of biological parameters such as α, β, and relative biological effectiveness for different types of tumors were used for the calculation., Results: Prescription doses with I-125, Pd-103, and Au-198 ranging from 10 to 160 Gy were converted into prescription doses with Cs-131. The difference in dose conversion factors with (Fr) and without (Fn) resensitization was significant but varied with different isotopes and different types of tumors. The conversion factors also varied with different doses. For I-125, the average values of Fr/Fn were 0.51/0.46, for fast growing tumors, and 0.88/0.77 for slow growing tumors. For Pd-103, the average values of Fr/Fn were 1.25/1.15 for fast growing tumors, and 1.28/1.22 for slow growing tumors. For Au-198, the average values of Fr/Fn were 1.08/1.25 for fast growing tumors, and 1.00/1.06 for slow growing tumors. Using the biological parameters for the HeLa/C4-I cells, the averaged value of Fr was 1.07/1.11 (rounded to 1.1), and the averaged value of Fn was 1.75/1.18. Fr of 1.1 has been applied to gynecological cancer implants with expected acute reactions and outcomes as expected based on extensive experience with permanent implants. The calculation also gave the average Cs-131 dose of 126 Gy converted from the I-125 dose of 144 Gy for prostate implants., Conclusions: Inclusion of an allowance for resensitization led to significant dose corrections for Cs-131 permanent implants, and should be applied to prescription dose calculation. The adjustment of the Cs-131 prescription doses with resensitization correction for gynecological permanent implants was consistent with clinical experience and observations. However, the Cs-131 prescription doses converted from other implant doses can be further adjusted based on new experimental results, clinical observations, and clinical outcomes.

Looking at Open Science and Open Data from a broad perspective. This is the idea behind "Scientific data sharing: an interdisciplinary workshop", an initiative designed to foster dialogue between scholars from different scientific domains which was organized by the Istituto Italiano di Antropologia in Anagni, Italy, 2-4 September 2013.We here report summaries of the presentations and discussions at the meeting. They deal with four sets of issues: (i) setting a common framework, a general discussion of open data principles, values and opportunities; (ii) insights into scientific practices, a view of the way in which the open data movement is developing in a variety of scientific domains (biology, psychology, epidemiology and archaeology); (iii) a case study of human genomics, which was a trail-blazer in data sharing, and which encapsulates the tension that can occur between large-scale data sharing and one of the boundaries of openness, the protection of individual data; (iv) open science and the public, based on a round table discussion about the public communication of science and the societal implications of open science. There were three proposals for the planning of further interdisciplinary initiatives on open science. Firstly, there is a need to integrate top-down initiatives by governments, institutions and journals with bottom-up approaches from the scientific community. Secondly, more should be done to popularize the societal benefits of open science, not only in providing the evidence needed by citizens to draw their own conclusions on scientific issues that are of concern to them, but also explaining the direct benefits of data sharing in areas such as the control of infectious disease. Finally, introducing arguments from social sciences and humanities in the educational dissemination of open data may help students become more profoundly engaged with Open Science and look at science from a broader perspective.

There has been a dramatic rise in the prevalence of IgE-mediated food allergy over recent decades, particularly among infants and young children. The cause of this increase is unknown but one putative factor is a change in the composition, richness and balance of the microbiota that colonize the human gut during early infancy. The coevolution of the human gastrointestinal tract and commensal microbiota has resulted in a symbiotic relationship in which gut microbiota play a vital role in early life immune development and function, as well as maintenance of gut wall epithelial integrity. Since IgE mediated food allergy is associated with immune dysregulation and impaired gut epithelial integrity there is substantial interest in the potential link between gut microbiota and food allergy. Although the exact link between gut microbiota and food allergy is yet to be established in humans, recent experimental evidence suggests that specific patterns of gut microbiota colonization may influence the risk and manifestations of food allergy. An understanding of the relationship between gut microbiota and food allergy has the potential to inform both the prevention and treatment of food allergy. In this paper we review the theory and evidence linking gut microbiota and IgE-mediated food allergy in early life. We then consider the implications and challenges for future research, including the techniques of measuring and analyzing gut microbiota, and the types of studies required to advance knowledge in the field.

A range of natural and artificial textiles are examined using terahertz time-domain spectroscopy. Different types of textiles are shown to have different terahertz optical properties, which may be employed for textile identification and to combat textile counterfeiting.

Purpose: Vision screening programs often rely on acuity measures to detect significant refractive error and clinicians use measures of acuity to monitor refractive treatment. This study investigated the effects of induced astigmatism on visual acuity (VA) using several paediatric acuity tests: the Keeler LogMAR crowded and single letter acuity tests, the single letter Sheridan Gardiner chart, and the crowded and single Kay picture tests., Methods: Six fully-corrected emmetropic adults had induced astigmatic blur imposed at different axes of astigmatism (90°, 180°, 135°, 45°). Astigmatic errors ranged from 0.75 to 3.50 DC. Monocular VA was measured with induced astigmatic blur for each acuity test. Participants and examiner were masked to the axis and power of the astigmatism., Results: All participants demonstrated similar variability in performance across acuity charts (p = 0.54). For all charts, there was a linear reduction in VA with increasing amounts of induced astigmatism. The Keeler crowded LogMAR acuity test required the least amount of astigmatic blur to exceed a 0.2 LogMAR threshold (1.17 D, for 90° induced astigmatism), while the crowded and single Kay pictures required the largest magnitudes (2.09 and 2.85 D for 90° induced astigmatism respectively). The most variable acuities were recorded within and between participants with the Sheridan Gardiner chart., Conclusions: The present study demonstrated that none of the acuity charts under test are likely to detect uncorrected astigmatic refractive error unless the magnitude of astigmatism is large. Given the limitations of other paediatric acuity charts under test, it is important that practitioners use a crowded, LogMAR letter chart as soon as it is feasible., (Ophthalmic & Physiological Optics © 2012 The College of Optometrists.)

Dissemination of prevention-focused evidence-based programs (EBPs) from research to community settings may improve population health and reduce health disparities, but such flow has been limited. Academic-community partnerships using community-based participatory research (CBPR) principles may support increased dissemination of EBPs to community-based organizations (CBOs). This qualitative study examined the EBP-related perceptions and needs of CBOs targeting underserved populations. As part of PLANET MassCONECT, a CBPR study, we conducted six key informant interviews with community leaders and four focus groups with CBO staff members in Boston, Worcester and Lawrence, Massachusetts, in 2008. Working definitions of EBPs among CBO staff members varied greatly from typical definitions used by researchers or funders. Key barriers to using EBPs included: resource constraints, program adaptation challenges and conflicts with organizational culture. Important facilitators of EBP usage included: program supports for implementation and adaptation, collaborative technical assistance and perceived benefits of using established programs. This exploratory study highlights differences among key stakeholders regarding the role of evidence in program planning and delivery. An updated perspective should better incorporate CBO perspectives on evidence and place greater, and much needed, emphasis on the impact of context for EBP dissemination in community settings.

Purpose: To show the effect of gold backing on dose rates for the USC #9 radioactive eye plaque., Methods: An I125 source (IsoAid model IAI-125A) and gold backing was modeled using MCNP5 Monte Carlo code. A single iodine seed was simulated with and without gold backing. Dose rates were calculated in two orthogonal planes. Dose calculation points were structured in two orthogonal planes that bisect the center of the source. A 2×2 cm matrix of spherical points of radius 0.2 mm was created in a water phantom of 10 cm radius. 0.2 billion particle histories were tracked. Dose differences with and without the gold backing were analyzed using Matlab., Results: The gold backing produced a 3% increase in the dose rate near the source surface (<1mm) relative to that without the backing. This was presumably caused by fluorescent photons from the gold. At distances between 1 and 2 cm, the gold backing reduced the dose rate by up to 12%, which we attribute to a lack of scatter resulting from the attenuation from the gold. Dose differences were most pronounced in the radial direction near the source center but off axis. The dose decreased by 25%, 65% and 81% at 1, 2, and 3 mm off axis at a distance of 1 mm from the source surface. These effects were less pronounced in the perpendicular dimension near the source tip, where maximum dose decreases of 2% were noted., Conclusions: I 125 sources embedded directly into gold troughs display dose differences of 2 - 90%, relative to doses without the gold backing. This is relevant for certain types of plaques used in treatment of ocular melanoma. Large dose reductions can be observed and may have implications for scleral dose reduction., (© 2012 American Association of Physicists in Medicine.)

Purpose: To verify the SBRT plans on CMS Xio treatment planning system using the Monte Carlo simulation and investigate the related issues., Methods: The SBRT plans with 6 MV were created on CMS Xio treatment planning system with superposition algorithm. The same patient's CT, beam geometry and MUs were used in the Monte Carlo simulation (MC) on MCSIM. MCSIM is an EGS4-based MC dose calculation system for photon and electron beams. The Monte Carlo plans were compared with the Xio plans to verify Xio superposition algorithm for SBRT. The electron disequilibrium was particularly investigated by comparing the DVHs for a 2-mm thick peel of the GTV. The beam energy was changed from 6 MV to 10 MV for MC to test energy effect on SBRT dosimetry., Results: Six SBRT lung plans created on Xio and delivered on Varian 21 EX linac were included in this study. The tumor GTV ranged from 1.4 cc to 11 cc and the dose ranged from 1950 cGy to 5400 cGy. The comparisons were made in terms of DVHs, mean doses, minimal doses, and maximal doses for GTV. The results showed all the dose values of Xio plans agreed with MC to within 2% with only two exceptions of 3% and 5%. The dose distribution in the peel of GTV followed the same pattern as the whole GTV. This indicated the Xio superposition algorithm has well accounted for electron disequilibrium. The 10-MV beams had both hot and cold spots from DVH comparison. This may be due to the large build-up region for high energy beams., Conclusions: The Xio superposition algorithm has adequately accounted for electron disequilibrium and can perform accurate dose calculation for SBRT. Compared to high energy beams, 6 MV is preferable in terms of the GTV coverage and dose homogeneity., (© 2012 American Association of Physicists in Medicine.)

Purpose: The constraints required for patient imaging dose received during image-guided radiotherapy differ from those applied in the diagnostic realm. Wide latitude in applied dose can be justified if it results in useful improvement in image quality. Currently, image acquisition parameters are chosen via broad categorizations in patient anatomy and imaging goal. Herein, we describe the development and early benchmarking of a patient-specific image planning system that is capable of predetermining the optimal acquisition parameters for a given level of patient dose and imaging goal., Methods: An algorithm was written in Matlab that performed a divergent ray-trace through a 3D CT data set and impinges on a flat imaging receptor. Energy-specific attenuation through each voxel of the CT data set is calculated to derive a net transmitted intensity. The detector response as a function of beam quality and exposure was measured and integrated into the algorithm. It is primarily this feature that distinguishes this from a traditional digitally reconstructed radiograph. Verification data was collected using a flat panel imager mounted onto a linear accelerator gantry and a lung phantom with an embedded nodule. Loss of object detectability was evaluated by measuring the visible diameter of the phantom nodule., Results: There is qualitative agreement between simulated and measured images in terms of contrast and object detectability. The simulation algorithm predicts both under-exposure and saturation of the detector over a range of beam qualities (80 keV to 120keV) and exposure levels. Object detectability erodes predictably above 60 mAs for at 80keV and above 15mAs for 120 keV for both simulated and measured images. Quantitative accuracy is currently limited by lack of beam heterogeneity, which will be added in further work., Conclusions: The feasibility and qualitative accuracy of an image planning system has been established., (© 2012 American Association of Physicists in Medicine.)

Plant infection by pathogenic fungi requires polarized secretion of enzymes, but little is known about the delivery pathways. Here, we investigate the secretion of cell wall-forming chitin synthases (CHSs) in the corn pathogen Ustilago maydis. We show that peripheral filamentous actin (F-actin) and central microtubules (MTs) form independent tracks for CHSs delivery and both cooperate in cell morphogenesis. The enzyme Mcs1, a CHS that contains a myosin-17 motor domain, is travelling along both MTs and F-actin. This transport is independent of kinesin-3, but mediated by kinesin-1 and myosin-5. Arriving vesicles pause beneath the plasma membrane, but only ~15% of them get exocytosed and the majority is returned to the cell centre by the motor dynein. Successful exocytosis at the cell tip and, to a lesser extent at the lateral parts of the cell requires the motor domain of Mcs1, which captures and tethers the vesicles prior to secretion. Consistently, Mcs1-bound vesicles transiently bind F-actin but show no motility in vitro. Thus, kinesin-1, myosin-5 and dynein mediate bi-directional motility, whereas myosin-17 introduces a symmetry break that allows polarized secretion.