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The dosimetric impact of volumetric modulated arc therapy (VMAT) in lung cancer compared with 3D conformal radiotherapy (3DCRT) is well known. However, this improvement is often associated with an increase in low doses. The aim of this study is to quantify these results more accurately.
For each patient treated with 3DCRT, a second VMAT treatment plan was calculated. Usual dosimetric parameters such as target coverage or dose to the organs at risk were used to achieve the comparisons.
For planning target volume, homogeneity and conformity indices showed superiority of VMAT (respectively 0·07 and 0·87) compared to 3DCRT (0·11 and 0·57). For spinal cord planning organ at risk volume, the median maximum dose was 45·6 Gy in 3DCRT against 19·3 Gy in VMAT. Heart volume receiving at least 35 Gy (V35) decreased from 15·64% in 3DCRT to 8·28% in VMAT. Oesophagus V50 was higher in 3DCRT (25·45%) than in VMAT (14·03%). The mean lung dose was 17·9 Gy in 3DCRT versus 15·5 Gy in VMAT. Moreover, volumes receiving 5, 10 and 15 Gy were not significantly different between the two techniques when VMAT was performed with partial arcs.
All the dosimetric parameters were improved with VMAT compared to the 3DCRT without increasing low doses when using partial arcs.
Equimolar mixtures of zero-dimensional graphene (SkySpring Nanomaterials, 1-5 nm particle size) and zinc ferrite nanoparticles (Alfa Aesar, 50 nm particle size) were exposed to mechanochemical activation by high-energy ball milling for time intervals of 0-12 hours. Their structural and magnetic properties were analyzed by Mӧssbauer spectroscopy and magnetic measurements. The spectra of zinc ferrite milled without graphene were fitted with one quadrupole-split doublet (quadrupole splitting 0.5 mm/s, isomer shift 0.23 mm/s) and indicated that zinc ferrite was superparamagnetic. The line width of the doublet increased from 0.41 to 0.64 mm/s, which correlates with a reduction in particle size as effect of the ball milling processing performed. When graphene was added to the milling powders, the Mӧssbauer spectra showed the appearance of another quadrupole doublet, with a quadrupole splitting of 0.84 mm/s and an isomer shift of -0.38 mm/s. Its abundance to the spectrum remained constant to 4.48% while the milling time was increased. This second doublet could be related to carbon atoms occupying neighborhoods in the proximity of iron atoms. Hysteresis loops were recorded in an applied magnetic field of 5 T at a temperature of 5 K. A change in the approach to saturation of the loop was observed, with saturation being achieved for the sample milled for 12 hours with graphene. Zero-field-cooling-field-cooling (ZFC-FC) was performed on all samples between 5-300 K with an applied magnetic field of 200 Oe. Graphene was found to stabilize the magnetic properties of the milled system of powders to a blocking temperature of about 90 K.
The Cape Parrot Poicephalus robustus is a habitat specialist, restricted to forest patches in the Eastern Cape (EC), KwaZulu-Natal (KZN) and Limpopo provinces of South Africa. Recent census estimates suggest that there are less than 1,600 parrots left in the wild, although historical data suggest that the species was once more numerous. Fragmentation of the forest biome is strongly linked to climate change and exploitation of the forest by the timber industry. We examine the subpopulation structure and connectivity between fragmented populations across the distribution of the species. Differences in historical and contemporary genetic structure of Cape Parrots is examined by including both modern samples, collected from 1951 to 2014, and historical samples, collected from 1870 to 1946. A total of 114 individuals (historical = 29; contemporary = 85) were genotyped using 16 microsatellite loci. We tested for evidence of partitioning of genotypes at both a temporal and spatial scales by comparing shifts in allelic frequencies of historical (1870–1946) and contemporary (1951–2014) samples across the distribution of the species. Tests for population bottlenecks were also conducted to determine if anthropogenic causes are the main driver of population decline in this species. Analyses identified three geographically correlated genetic clusters. A southern group restricted to forest patches in the EC, a central group including birds from KZN and a genetically distinct northern Limpopo cluster. Results suggest that Cape Parrots have experienced at least two population bottlenecks. An ancient decline during the mid-Holocene (∼ 1,800-3,000 years before present) linked to climate change, and a more recent bottleneck, associated with logging of forests during the early 1900s. This study highlights the effects of climate change and human activities on an endangered species associated with the naturally fragmented forests of eastern South Africa. These results will aid conservation authorities with the planning and implementation of future conservation initiatives. In particular, this study emphasises the Eastern Cape mistbelt forests as an important source population for the species and calls for stronger conservation of forest patches in South Africa to promote connectivity of forest taxa.
The number of people avoiding gluten is growing in many Western countries. However, little information is available on their sociodemographic and dietary profiles. We aimed to describe sociodemographic, behavioural and dietary profiles of participants avoiding gluten in the NutriNet-Santé cohort. Participants of the NutriNet-Santé cohort – excluding coeliac patients – who completed a questionnaire about food exclusions, with complete data on sociodemographic characteristics and dietary intake were included (n 20 456). Food group consumptions and nutrient intakes according to self-reported avoidance of gluten were estimated using ANCOVA adjusted for age, sex and daily energy intake. Based on principal component analysis, three dietary patterns (DP) were identified. Association between DP and avoidance of gluten was investigated using multivariate logistic regression. All data were weighted on the French census. A total of 10·31 (95 % CI 9·90, 10·73) % of the participants declared avoiding gluten, of which 1·65 % totally. They were more likely to be women, older persons, non-smokers, to have a lower educational level and declared more food intolerances. They had higher consumption of fruit, vegetables and lower consumption of dairy products, salty/sweet and fatty foods and alcohol. After adjustments on confounders, a healthy dietary pattern was positively associated with total gluten avoidance (ORQuintile5vsQuintile1 = 14·44, 95 % CI 8·62, 24·19). Our study highlighted that, in this population, individuals who avoid gluten from their diet tend to have a diet more favourable to health. These results can serve as a basis for future studies investigating the potential consequences of a gluten-free diet in non-coeliac population.
OBJECTIVES/SPECIFIC AIMS: To examine maternal morbidity and its related social determinants among women experiencing homelessness during pregnancy. METHODS/STUDY POPULATION: This study will use an exploratory sequential mixed method design to explore and examine the structural, interpersonal and individual factors contributing to maternal morbidity among a convenience sample of 150 English speaking women experiencing homelessness during a pregnancy within the last 3 years in Baltimore. In the qualitative phase of the study, we will conduct semi-structured interviews with 15 women purposively sampled to refine the relationships between resilience, social determinants of health and multilevel factors that impact maternal morbidities. Factors of interest include prenatal care received, barriers and facilitators to receiving prenatal care, maternal morbidities, social support, and strategies used to manage their condition during this time. Using the findings from the qualitative phase, a quantitative survey will be developed to gather data on topics that emerged in the interviews. In addition, the Housing Instability Index will be used to measure the degree of homelessness as defined by the degree of housing instability in a 6-month period. Using the 25-item Connor-Davidson Resilience Scale, resilience levels among women in the sample will be assessed as a moderating factor in the examination of the relationship between a pregnant woman’s homeless status and maternal morbidity. Descriptive statistics and logistical regression tests will be used to analyze these relationships while controlling for other structural, interpersonal, and individual factors that may be associated with maternal morbidity. RESULTS/ANTICIPATED RESULTS: Qualitatively we expect to gain insight into the relationship between the extrinsic and intrinsic factors impacting maternal morbidities and the health behaviors and practices used by women to manage their pregnancy while homeless. These findings will inform the quantitative survey development and help generalize the quantitative findings. We expect to identify the common morbidities in this population we anticipate that there will be differences in maternal morbidity among the different types of homelessness. Maternal morbidity will be higher among women with a greater degree of homelessness. Resilience will have a moderating effect on the relationship between homelessness and maternal morbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: This study, to our knowledge, is the first to look at maternal morbidity in this population. Additionally, this study seeks to move current research from examining infant outcomes at birth among mothers experiencing homelessness to understanding the maternal morbidities during this period. Long term, good maternal health has significant implications for the health of a mother’s future pregnancies and a risk reduction of adverse chronic conditions. Study results will provide the preliminary knowledge needed to guide further research leading to clinical approaches that promote better maternal health in this population. Lastly, the study findings will inform policy by characterizing the quality and strength of evidence of the adverse maternal health effects associated with the experience of homelessness.
Lung ultrasound has value in diagnosing dyspnea. The main objective of this study was to evaluate the accuracy of a modified lung ultrasound (MLUS) score to predict the severity of acute dyspnea in elderly patients.
This was an observational single-centre study including patients over age 64 admitted to the emergency department for acute dyspnea with hypoxia. Participants had an early lung ultrasound performed by a dedicated emergency physician, followed by the usual care by a team blinded to the lung ultrasound results. Patients were allocated by disposition to either a critical care (CC) group (patients who needed admission to the intensive care unit [ICU] and/or who died within 48 h) or a standard care group.
Among 137 patients analysed (mean age 79 ± 13 years, 74 [54%] women), 43 (31%) were categorized into the CC group. The time taken to obtain the MLUS was 30 ± 22 min. The area under the receiver operating characteristic curve of the MLUS for predicting the CC group was 0.97 (0.92–0.99; p < 0.01) with a cut-off set strictly above 17 for 93% sensitivity (81–99), 99% specificity (94–100), a positive predictive value of 98% (87–100), a negative predictive value of 97% (91–99), a positive likelihood ratio of 86, a negative likelihood ratio of 0.07, and a diagnostic accuracy of 97% (93–99). In a multivariate analysis, the MLUS was the only independent associated factor for the CC group.
An early lung ultrasound score can predict the need for ICU admission and/or death within 48 hours in elderly dyspneic patients.
Carbon-14 (radiocarbon, 14C) is a long-lived radionuclide (5730 yr) of interest regarding the safety for the management of intermediate level wastes (ILW). The present study gives an overview of the release of 14C from irradiated Zircaloy cladding in alkaline media. 14C is found either in the alloy part of Zircaloy cladding due to the neutron activation of 14N impurities by 14N(n,p)14C reaction, or in the oxide layer (ZrO2) formed at the metal surface by the neutron activation of 17O from UO2 or (U-Pu)O2 fuel and water from the primary circuit in the reactor by 17O(n,α)14C reaction. Various irradiated and unirradiated Zircaloys have been studied. The total 14C inventory has been determined both experimentally and by calculations. The results seem to be in good agreement. Leaching experiments were conducted in alkaline media for several time durations. 14C was mainly released as carboxylic acids. Further, corrosion measurements were performed by using both hydrogen measurements and electrochemical measurements. The corrosion rate (CR) ranges from a few nm/yr to 100 nm/yr depending on the surface conditions and the method used for measurement. From a safety assessment point of view, the instant release fraction (IRF) was determined on irradiated Zircaloy-2. The results showed that the 14C inventory in the oxide was significantly below the 20% commonly used in safety case assessments.
The Neolithic transition is a particularly favorable field of research for the study of the emergence and evolution of cultures and cultural phenomena. In this framework, high-precision chronologies are essential for decrypting the rhythms of emergence of new techno-economic traits. As part of a project exploring the conditions underlying the emergence and dynamics of the development of the first agro-pastoral societies in the Western Mediterranean, this paper proposes a new chronological modeling. Based on 45 new radiocarbon (14C) dates and on a Bayesian statistical framework, this work examines the rhythms and dispersal paths of the Neolithic economy both on coastal and continental areas. These new data highlight a complex and far less unidirectional dissemination process than that envisaged so far.
The patient portal may be an effective method for administering surveys regarding participant research experiences but has not been systematically studied.
We evaluated 4 methods of delivering a research participant perception survey: mailing, phone, email, and patient portal. Participants of research studies were identified (n=4013) and 800 were randomly selected to receive a survey, 200 for each method. Outcomes included response rate, survey completeness, and cost.
Among those aged <65 years, response rates did not differ between mail, phone, and patient portal (22%, 29%, 30%, p>0.07). Among these methods, the patient portal was the lowest-cost option. Response rates were significantly lower using email (10%, p<0.01), the lowest-cost option. In contrast, among those aged 65+ years, mail was superior to the electronic methods (p<0.02).
The patient portal was among the most effective ways to reach research participants, and was less expensive than surveys administered by mail or telephone.
Prolonged conflict and economic instability challenge the existing support networks in families and society places significant stress on both adults and adolescents. Exploring individual, family and social factors that increase the likelihood of or protect adolescents from negative outcomes are important to the development of evidence-based prevention and response programing in global settings.
Examine the relationship between parent mental health and experience/perpetration of intimate partner violence (IPV) and adolescent behaviors, stigma, and school attendance. The relationship is further examined for differences by gender.
Secondary analysis of data from an ongoing comparative effectiveness trial of a productive asset transfer program in eastern Democratic Republic of Congo (DRC).
Three hundred and eighty-eight adolescent and parent dyads were included in the analysis. The analysis demonstrated that parent mental health and IPV can have a negative impact their children's well-being and the impact is different for boys and girls, likely linked to gender roles and responsibilities in the home and community. Social relationships of adolescents, as reported through experienced stigma, were negatively impacted for both boys and girls. Parent report of symptoms of PTSD and depression had a stronger negative effect on girls’ outcomes, including experienced stigma, externalizing behaviors, and missed days of school than boys. For adolescent boys, their parent's report of IPV victimization/perpetration was associated with more negative behaviors at the 8-month follow-up assessment.
The findings reinforce the critical importance of interventions that engage parents and their children in activities that advance health and improve relationships within the family.
Cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, but risk factors associated with cognitive deficits in euthymic BD are still poorly understood. We aimed to validate classification criteria for the identification of clinically significant cognitive impairment, based on psychometric properties, to estimate the prevalence of neuropsychological deficits in euthymic BD, and identify risk factors for cognitive deficits using a multivariate approach.
We investigated neuropsychological performance in 476 euthymic patients with BD recruited via the French network of BD expert centres. We used a battery of tests, assessing five domains of cognition. Five criteria for the identification of neuropsychological impairment were tested based on their convergent and concurrent validity. Uni- and multivariate logistic regressions between cognitive impairment and several clinical and demographic variables were performed to identify risk factors for neuropsychological impairment in BD.
One cut-off had satisfactory psychometric properties and yielded a prevalence of 12.4% for cognitive deficits in euthymic BD. Antipsychotics use were associated with the presence of a cognitive deficit.
This is the first study to validate a criterion for clinically significant cognitive impairment in BD. We report a lower prevalence of cognitive impairment than previous studies, which may have overestimated its prevalence. Patients with euthymic BD and cognitive impairment may benefit from cognitive remediation.
A study was carried out, from 2012 to 2015, in 10 French départements to estimate the serological prevalence of Q fever and the frequency of abortive episodes potentially related to Coxiella burnetii in a large sample of cattle, sheep and goat herds. The serological survey covered 731 cattle, 522 sheep and 349 goat herds, randomly sampled. The frequency of abortive episodes potentially related to C. burnetii was estimated by investigating series of abortions in 2695 cattle, 658 sheep and 105 goat herds using quantitative polymerase chain reaction analyses and complementary serological results when needed. The average between-herd seroprevalence was significantly lower for cattle (36·0%) than for sheep (55·7%) and goats (61·0%) and significantly higher for dairy herds (64·9% for cattle and 75·6% for sheep) than for meat herds (18·9% for cattle and 39·8% for sheep). Within-herd seroprevalence was also significantly higher for goats (41·5%) than for cattle (22·2%) and sheep (25·7%). During the study period, we estimated that 2·7% (n = 90), 6·2% (n = 48) and 16·7% (n = 19) of the abortive episodes investigated could be ‘potentially related to C. burnetii’in cattle, sheep and goat herds, respectively. Overall, strong variability was observed between départements and species, suggesting that risk factors such as herd density and farming practices play a role in disease transmission and maintenance.