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Objective: Investigate the sleep hygiene and quality of emerging adults with a CMC compared to healthy peers as well as potential predictors of sleep quality. Participants: College students with and without a CMC (n = 137 per group; aged 18-23 years) at a Midwestern university. Methods: Participants reported on anxious and depressive symptoms, sleep quality, sleep hygiene, and illness uncertainty. Results: College students with a CMC reported poorer sleep quality (Adolescent Sleep Quality Scale-Revised) and hygiene (Adolescent Sleep Hygiene Scale-Revised) than the non-CMC group. The indirect effect of internalizing symptoms on sleep quality via cognitive-emotional arousal was only significant in the CMC. Illness uncertainty demonstrated a significant indirect effect on sleep quality though the consecutive influence of internalizing symptoms and cognitive-emotional arousal. Conclusions: Emerging adults with CMCs may experience poorer sleep outcomes than peers. Illness uncertainty, internalizing symptoms, and cognitive-emotional arousal appear relevant to sleep outcomes, suggesting clinical implications for these constructs.

Abstract Background Photon-counting detector (PCD) technology has the potential to reduce noise in computed tomography (CT). This study aimed to carry out a voxelwise noise characterization for a clinical PCD-CT scanner with a model-based iterative reconstruction algorithm (QIR). Methods Forty repeated axial acquisitions (tube voltage 120 kV, tube load 200 mAs, slice thickness 0.4 mm) of a homogeneous water phantom and CTP404 module (Catphan-504) were performed. Water phantom acquisitions were also performed on a conventional energy-integrating detector (EID) scanner with a sinogram/image-based iterative reconstruction algorithm, using similar acquisition/reconstruction parameters. For smooth/sharp kernels, filtered back projection (FBP)- and iterative-reconstructed images were obtained. Noise maps, non-uniformity index (NUI) of noise maps, image noise histograms, and noise power spectrum (NPS) curves were computed. Results For FBP-reconstructed images of water phantom, mean noise was (smooth/sharp kernel) 11.7 HU/51.1 HU and 18.3 HU/80.1 HU for PCD-scanner and EID-scanner, respectively, with NUI values for PCD-scanner less than half those for EID-scanner. Percentage noise reduction increased with increasing iterative power, up to (smooth/sharp kernel) 57.7%/72.5% and 56.3%/70.1% for PCD-scanner and EID-scanner, respectively. For PCD-scanner, FBP- and QIR-reconstructed images featured an almost Gaussian distribution of noise values, whose shape did not appreciably vary with iterative power. Noise maps of CTP404 module showed increased NUI values with increasing iterative power, up to (smooth/sharp kernel) 15.7%/9.2%. QIR-reconstructed images showed limited low-frequency shift of NPS peak frequency. Conclusion PCD-CT allowed appreciably reducing image noise while improving its spatial uniformity. QIR algorithm decreases image noise without modifying its histogram distribution shape, and partly preserving noise texture. Relevance statement This phantom study corroborates the capability of photon-counting detector technology in appreciably reducing CT imaging noise and improving spatial uniformity of noise values, yielding a potential reduction of radiation exposure, though this needs to be assessed in more detail. Key Points First voxelwise characterization of noise for a clinical CT scanner with photon-counting detector technology. Photon-counting detector technology has the capability to appreciably reduce CT imaging noise and improve spatial uniformity of noise values. In photon-counting CT, a model-based iterative reconstruction algorithm (QIR) allows decreasing effectively image noise. This is done without modifying noise histogram distribution shape, while limiting the low-frequency shift of noise power spectrum peak frequency. Graphical Abstract

Objective: To examine the relative contribution of transition readiness (i.e., healthcare self-management) to health-related quality of life (HRQoL) among emerging adult (EA) college students without a chronic medical condition (CMC). Participants: College students (n = 2372; Mage = 19.32, SD = 1.26) from a Midwestern university. Methods: Participants completed online measures of demographics, HRQoL, and transition readiness. Results: Hierarchical regression analyses found transition readiness accounted an additional 3-4% of the variability in mental and physical HRQoL (p < 0.001), beyond demographic factors. 11.3% of EAs reported overall mastery of transition readiness, with navigating health insurance being the weakest area. Conclusions: Findings support the consensus that transition readiness is relevant to HRQoL for "all" EAs, including those without a CMC. EAs without a CMC demonstrate relatively weak transition readiness skills. Primary and university-based healthcare might consider programs supporting transition readiness and HRQoL among underresourced EAs.

Objectives: Liver metastases occur in 45% of patients with advanced metastatic medullary thyroid cancer (MTC). Transarterial radioembolization (TARE) has been proposed to treat liver metastases (LM), especially in neuroendocrine tumors. The aim of this study was to investigate the biochemical (calcitonin and carcino-embryonic antigen) and objective response of liver metastases from MTC to TARE. Methods: TARE is an internal radiotherapy in which microspheres loaded with β-emitting yttrium-90 (90Y) are delivered into the hepatic arteries that supply blood to LM. Eight patients with progressive multiple LM underwent TARE and were followed prospectively. They were clinically, biochemically and radiologically evaluated at 1, 4, 12 and 18 months after TARE. Results: Two patients were excluded from the analysis due to severe liver injury and death due to extrahepatic disease progression, respectively. One month after TARE, a statistically significant (P = 0.02) reduction of calcitonin was observed in all patients and remained clinically relevant during follow-up; reduction of CEA , although not significant, was found in all patients. Significant reduction of liver tumor mass was observed 1, 4 and 12 months after TARE (P = 0.007, P = 0.004, P = 0.002, respectively). After 1 month, three of six patients showed partial response (PR) and three of six stable disease (SD) according to RECIST 1.1, while five of six patients had a PR and one of six a SD according to mRECIST. The clinical response remained relevant 18 months after TARE. Excluding one patient, all others showed only a slight and transient increase in liver enzymes. Conclusions: TARE is effective in LM treatment of MTC. The absence of severe complications and the good tolerability make TARE a valid therapeutic strategy when liver LM are multiple and progressive.

Radiotherapy with very high energy electrons has been investigated for a couple of decades as an effective approach to improve dose distribution compared to conventional photon-based radiotherapy, with the recent intriguing potential of high dose-rate irradiation. Its practical application to treatment has been hindered by the lack of hospital-scale accelerators. High-gradient laser-plasma accelerators (LPA) have been proposed as a possible platform, but no experiments so far have explored the feasibility of a clinical use of this concept. We show the results of an experimental study aimed at assessing dose deposition for deep seated tumours using advanced irradiation schemes with an existing LPA source. Measurements show control of localized dose deposition and modulation, suitable to target a volume at depths in the range from 5 to 10 cm with mm resolution. The dose delivered to the target was up to 1.6 Gy, delivered with few hundreds of shots, limited by secondary components of the LPA accelerator. Measurements suggest that therapeutic doses within localized volumes can already be obtained with existing LPA technology, calling for dedicated pre-clinical studies.

Objective: Investigate the sleep hygiene and quality of emerging adults with a CMC compared to healthy peers as well as potential predictors of sleep quality. Participants: College students with and without a CMC (n = 137 per group; aged 18–23 years) at a Midwestern university. Methods: Participants reported on anxious and depressive symptoms, sleep quality, sleep hygiene, and illness uncertainty. Results: College students with a CMC reported poorer sleep quality (Adolescent Sleep Quality Scale-Revised) and hygiene (Adolescent Sleep Hygiene Scale-Revised) than the non-CMC group. The indirect effect of internalizing symptoms on sleep quality via cognitive-emotional arousal was only significant in the CMC. Illness uncertainty demonstrated a significant indirect effect on sleep quality though the consecutive influence of internalizing symptoms and cognitive-emotional arousal. Conclusions: Emerging adults with CMCs may experience poorer sleep outcomes than peers. Illness uncertainty, internalizing symptoms, and cognitive-emotional arousal appear relevant to sleep outcomes, suggesting clinical implications for these constructs. [ABSTRACT FROM AUTHOR]

Background: Photon-counting detector (PCD) technology has the potential to reduce noise in computed tomography (CT). This study aimed to carry out a voxelwise noise characterization for a clinical PCD-CT scanner with a model-based iterative reconstruction algorithm (QIR). Methods: Forty repeated axial acquisitions (tube voltage 120 kV, tube load 200 mAs, slice thickness 0.4 mm) of a homogeneous water phantom and CTP404 module (Catphan-504) were performed. Water phantom acquisitions were also performed on a conventional energy-integrating detector (EID) scanner with a sinogram/image-based iterative reconstruction algorithm, using similar acquisition/reconstruction parameters. For smooth/sharp kernels, filtered back projection (FBP)- and iterative-reconstructed images were obtained. Noise maps, non-uniformity index (NUI) of noise maps, image noise histograms, and noise power spectrum (NPS) curves were computed. Results: For FBP-reconstructed images of water phantom, mean noise was (smooth/sharp kernel) 11.7 HU/51.1 HU and 18.3 HU/80.1 HU for PCD-scanner and EID-scanner, respectively, with NUI values for PCD-scanner less than half those for EID-scanner. Percentage noise reduction increased with increasing iterative power, up to (smooth/sharp kernel) 57.7%/72.5% and 56.3%/70.1% for PCD-scanner and EID-scanner, respectively. For PCD-scanner, FBP- and QIR-reconstructed images featured an almost Gaussian distribution of noise values, whose shape did not appreciably vary with iterative power. Noise maps of CTP404 module showed increased NUI values with increasing iterative power, up to (smooth/sharp kernel) 15.7%/9.2%. QIR-reconstructed images showed limited low-frequency shift of NPS peak frequency. Conclusion: PCD-CT allowed appreciably reducing image noise while improving its spatial uniformity. QIR algorithm decreases image noise without modifying its histogram distribution shape, and partly preserving noise texture. Relevance statement: This phantom study corroborates the capability of photon-counting detector technology in appreciably reducing CT imaging noise and improving spatial uniformity of noise values, yielding a potential reduction of radiation exposure, though this needs to be assessed in more detail. Key Points: First voxelwise characterization of noise for a clinical CT scanner with photon-counting detector technology. Photon-counting detector technology has the capability to appreciably reduce CT imaging noise and improve spatial uniformity of noise values. In photon-counting CT, a model-based iterative reconstruction algorithm (QIR) allows decreasing effectively image noise. This is done without modifying noise histogram distribution shape, while limiting the low-frequency shift of noise power spectrum peak frequency. [ABSTRACT FROM AUTHOR]

Abstract Radiomics is emerging as a promising and useful tool in cardiac magnetic resonance (CMR) imaging applications. Accordingly, the purpose of this study was to investigate, for the first time, the effect of image resampling/discretization and filtering on radiomic features estimation from quantitative CMR T1 and T2 mapping. Specifically, T1 and T2 maps of 26 patients with hypertrophic cardiomyopathy (HCM) were used to estimate 98 radiomic features for 7 different resampling voxel sizes (at fixed bin width), 9 different bin widths (at fixed resampling voxel size), and 7 different spatial filters (at fixed resampling voxel size/bin width). While we found a remarkable dependence of myocardial radiomic features from T1 and T2 mapping on image filters, many radiomic features showed a limited sensitivity to resampling voxel size/bin width, in terms of intraclass correlation coefficient (> 0.75) and coefficient of variation (

Abstract Radioembolization is a valuable therapeutic option in patients with unresectable intrahepatic cholangiocarcinoma. The essential implementation of the absorbed dose calculation methods should take into account also the specific tumor radiosensitivity, expressed by the α parameter. Purpose of this study was to retrospectively calculate it in a series of patients with unresectable intrahepatic cholangiocarcinoma submitted to radioembolization. Twenty-one therapeutic procedures in 15 patients were analysed. Tumor absorbed doses were calculated processing the post-therapeutic 90Y-PET/CT images and the pre-treatment contrast-enhanced CT scans. Tumor absorbed dose and pre- and post-treatment tumor volumes were used to calculate α and α3D parameters (dividing targeted liver in n voxels of the same volume with specific voxel absorbed dose). A tumor volume reduction was observed after treatment. The median of tumor average absorbed dose was 93 Gy (95% CI 81–119) and its correlation with the residual tumor mass was statistically significant. The median of α and α3D parameters was 0.005 Gy−1 (95% CI 0.004–0.008) and 0.007 Gy−1 (95% CI 0.005–0.015), respectively. Multivariate analysis showed tumor volume and tumor absorbed dose as significant predictors of the time to tumor progression. The knowledge of radiobiological parameters gives the possibility to decide the administered activity in order to improve the outcome of the treatment.

Abstract The morbidity and mortality of cryptococcal meningoencephalitis (CM) in previously healthy, HIV-negative individuals is increasingly recognized. We administered a healthcare associated quality of life (QOL) survey to the largest longitudinally followed cohort of these patients in the United States. We identified moderate or severe self-reported impairment in at least one QOL domain in 61% of subjects at least one year following diagnosis. Self-reported cognitive impairment was noted in 52% and sleep disturbance was noted in 55%. This is the first comprehensive study of cross-sectional long-term QOL in previously healthy patients following cryptococcal infection.

Abstract Background To propose a practical and simple method to individually evaluate the average absorbed dose for digital breast tomosynthesis. Methods The method is based on the estimate of incident air kerma (k a,i ) on the breast surface. An analytical model was developed to calculate the k a,i from the tube voltage, tube load, breast thickness, x-ray tube yield, and anode-filter combination. A homogeneous phantom was employed to simulate the breast in experimental measurements and to assess the dose-depth relationship. The k a,i values were employed to calculate the “average absorbed breast dose” (2ABD) index. Four mammographic units were used to develop and test our method under many conditions close to clinical settings. The average glandular dose (AGD) calculated following the method described by Dance et al., and the 2ABD computed through our method (i.e., from the exposure parameters) were compared in a number of conditions. Results A good agreement was obtained between the k a,i computed through our model and that measured under different clinical conditions: discrepancies < 6% were found in all conditions. 2ABD matches with a good accuracy the AGD for a 100% glandular-breast: the minimum, maximum, and mean differences were < 0.1%, 7%, and 2.4%, respectively; the discrepancies increase with decreasing breast glandularity. Conclusions The proposed model, based on only few exposure parameters, represents a simple way to individually calculate an index, 2ABD, which can be interpreted as the average absorbed dose in a homogeneous phantom, approximating a 100% glandular breast. The method could be easily implemented in any mammographic device performing DBT.

Radiomics and artificial intelligence have the potential to become a valuable tool in clinical applications. Frequently, radiomic analyses through machine learning methods present issues caused by high dimensionality and multicollinearity, and redundant radiomic features are usually removed based on correlation analysis. We assessed the effect of preprocessing—in terms of voxel size resampling, discretization, and filtering—on correlation-based dimensionality reduction in radiomic features from cardiac T1 and T2 maps of patients with hypertrophic cardiomyopathy. For different combinations of preprocessing parameters, we performed a dimensionality reduction of radiomic features based on either Pearson’s or Spearman’s correlation coefficient, followed by the computation of the stability index. With varying resampling voxel size and discretization bin width, for both T1 and T2 maps, Pearson’s and Spearman’s dimensionality reduction produced a slightly different percentage of remaining radiomic features, with a relatively high stability index. For different filters, the remaining features’ stability was instead relatively low. Overall, the percentage of eliminated radiomic features through correlation-based dimensionality reduction was more dependent on resampling voxel size and discretization bin width for textural features than for shape or first-order features. Notably, correlation-based dimensionality reduction was less sensitive to preprocessing when considering radiomic features from T2 compared with T1 maps.

Objective Illness intrusiveness refers to the subjective cognitive appraisal of a chronic health condition interfering in daily, valued activities and may be highly relevant for parents of children with atypical genital appearance due to differences of sex development (DSD). However, a measure of illness intrusiveness has not been validated for this population. The current study aimed to evaluate the factor structure of the Illness Intrusiveness Scale for Parents (IIS-P) and examine convergent validity. Methods Participants included 102 parents (M age = 33.39 years, SD  =   6.48; 58% mothers) of 65 children (<2 years old) diagnosed with DSD participating in a larger, longitudinal study. Parents completed the IIS-P as well as self-report measures of stigma, and anxious and depressive symptoms. An exploratory factor analysis (EFA) was conducted. Results EFA results supported a 1-factor intrusiveness solution (α  =  .93), as well as a 2-factor solution measuring intrusiveness on daily living (α  =  .92) and community connectedness (α  =  .85). The 1-factor solution and both factors of the 2-factor solution demonstrated significant convergent validity with stigma as well as anxious and depressive symptoms. Conclusions Support emerged for both 1- and 2-factor solutions of the IIS-P in parents of children with DSD. The decision to evaluate illness intrusiveness as a total score or to examine the subscales of daily living and community connectedness should be tailored to the unique aims of researchers and clinicians. Future research should conduct a confirmatory factor analysis with both 1- and 2-factor models with larger, more diverse samples of caregivers. [ABSTRACT FROM AUTHOR]

Background: In this work a new method for the Mean Glandular Dose evaluation in digital breast tomosynthesis (DBT) is presented. Methods: Starting from the experimental-based dosimetric index, 2ABD, which represents the average absorbed breast dose, the mean glandular dose MGD2ABD was calculated using a conversion function of glandularity f(G), obtained through the use of Monte Carlo simulations. Results: f(G) was computed for a 4.5 cm thick breast: from its value MGD2ABD for different compressed breast thicknesses and glandularities was obtained. The comparison between MGD2ABD estimates and the dosimetric index provided in the current dosimetry protocols, following the Dance's approach, MGDDance, showed a good agreement (

Пандемія COVID-19 вплинула на усі аспекти економічної діяльності. Не стала винятком і поведінка споживачів. Заходи по соціальному дистанціюванню, самоізоляція, карантин, прийняті в багатьох країнах, та інші чинники створили нові споживчі тенденції, які потребують деталізації. Метою статті є виявлення особливостей поведінки споживачів в умовах COVID-19. Зміни в умовах пандемії коронавірусу торкнулися структури та обсягів споживання, потреб населення і, відповідно, поведінки споживачів. У споживачів з’явилися схильність до накопичення, зменшення споживання «на ходу», зростання зацікавленості до товарів у великих упаковках, вони навчилися творчо та інноваційно імпровізувати. На якийсь час відбулося стирання меж між професійним і побутовим життям, оскільки споживач не завжди мав змогу зайти до магазину, магазин «прийшов до покупця». Споживачам довелося прийняти новітні технології, які полегшують роботу, навчання та споживання. Вони почали більше турбуватися про себе, своїх рідних, близьких та суспільство в цілому. Нарешті, державна політика також нав'язала нові звички споживання, особливо в громадських місцях.

In this paper, a biofuel production supply chain optimization framework is developed that can supply the fuel demand for 10% of Ontario. Different biomass conversion technologies are considered, such as pyrolysis and gasification and subsequent hydro processing and the Fischer-Tropsch process. A supply chain network approach is used for the modeling, which enables the optimization of both the biorefinery locations and the associated transportation networks. Gasification of corn stover is examined to convert waste biomass into valuable fuel. Biomass-derived fuel has several advantages over traditional fuels including substantial greenhouse gas reduction, generating higher quality synthetic fuels, providing a use for biomass waste, and potential for use without much change to existing infrastructure. The objective of this work is to show the feasibility of the use of corn stover as a biomass feedstock to a hydrocarbon biofuel supply chain in Ontario using a mixed-integer linear programming model while accounting for the uncertainty in the availability of corn stover. In the case study, the exact number of biorefineries is left as a policy decision and the optimization is carried out over a range of the possible numbers of facilities. The results obtained from the case study suggests implementing gasification technology followed by Fischer-Tropsch at two different sites in Ontario. The optimal solution satisfied 10% of the yearly fuel demand of Ontario with two production plants (14.8 billion L of fuel) and requires an investment of $42.9 billion, with a payback period of about 3 years.