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An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.
Methods and materials:
Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.
Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.
This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.
Photovoltaics made from organic–inorganic hybrid perovskite semiconductors are attracting significant interest due to their ability to harvest sunlight with remarkable efficiency. The presence of lead in the best performing devices raises concerns regarding their toxicity, a problem that may create barriers to commercialization. Hybrid perovskites with reduced lead content are being investigated to overcome this issue and here we evaluate bismuth as a possible lead substitute. For a series of hybrid perovskite films with the general composition CH3NH3(PbyBi1−y)I3−xClx, we characterize their optical and structural properties using UV–Vis spectroscopy, scanning electron microscopy and grazing incidence wide angle X-ray scattering. We show that they form crystalline structures with an optical band gap, around 2 eV for CH3NH3BiI3. However, preliminary solar cell tests show low power conversion efficiencies (<0.01%) due to both incomplete precursor conversion and material de-wetting from the substrate. The overall outcome is severely limited photocurrent. With current processing methods the general applicability of hybrid bismuth perovskites in photovoltaics may be limited.
Zhong Hui (a.d. 225–264) was a major, albeit neglected figure in third- century Chinese intellectual history. Author of a Laozi commentary and a treatise on the relationship between “capacity” (cat) and “nature” (xing), Zhong Hui played a significant role in the development of xuanxue (Learning of the Mysterious Dao), which came into prominence during the early Wei dynasty and dominated the Chinese intellectual scene well into the sixth century. This essay presents a reconstructed version of Zhong Hui's Laozi commentary and compares Zhong's approach with Wang Bi's. Zhong Hui's work on “capacity and nature” (caixing) captures a major debate in early xuanxue philosophy and will be scrutinized also in this discussion.
To determine the outcomes of patients discharged from the emergency department (ED) with a bloodstream infection (BSI) and how these outcomes are influenced by antibiotic treatment.
We identified every BSI in adult patients discharged from our ED to the community between July 1, 2002, and March 31, 2011. The medical records of all cases were reviewed to determine antibiotic treatment in the ED and at discharge. Microorganism sensitivities were used to determine whether antibiotics were appropriate. These data were linked to population-based administrative data to determine specific patient outcomes within the subsequent 2-week period: death, urgent hospitalization, or an unplanned return to the ED.
A total of 480 adults with BSI were identified (1.49 cases per 1,000 adults discharged from the department). Compared to controls (321,048 patients), BSI patients had a significantly higher risk of urgent hospitalization (adjusted OR 2.1 [95% CI 1.6–2.8]) and unplanned return to the ED (adjusted OR 4.1 [95% CI 3.3–4.9]). Outcome risk was significantly lowered in BSI patients who received appropriate antibiotics in the ED and at discharge. In elderly patients, the risk of urgent hospitalization increased significantly as the time to appropriate antibiotics was delayed.
BSI patients discharged from the ED have a significantly increased risk of urgent hospitalization and unplanned return to the ED in the subsequent 2 weeks. These risks decrease significantly with the timely provision of appropriate antibiotics. Our results support the aggressive use of measures ensuring that such patients receive appropriate antibiotics as soon as possible.
Light-emitting diodes (LEDs) based on p-GaN/ZnO heterojunction were fabricated. GaN was deposited on sapphire using metal-organic chemical vapor deposition (MOCVD), and two kinds of ZnO i.e. ZnO thin film deposited by sputtering and ZnO nanorods (NRs) grown by hydrothermal method were used as n-type layer respectively. MgO film with the thickness around 10 nm was deposited by electron-beam deposition to act as an interlayer between GaN and ZnO. Photoluminescence, electroluminescence and I-V curves were measured to compare the properties of GaN based heterojunction LEDs with different architectures. The existence of MgO interlayer as well as the morphology of ZnO obviously influenced the electrical and optical properties of GaN based LEDs. The effect of MgO interlayer on ZnO growth, properties and I-V curves and emission spectra of LEDs is discussed in detail.
A new record of Crambionella stuhlmanni is reported from the east coast of South Africa. The material is described using quantitative morphological data, and mitochondrial (CO1) and nuclear (ITS-1) sequence data. The species can be diagnosed by a combination of morphological features including the presence of conical projections on velar lappets, the absence of orbicular appendages among mouthlets and the short length of the terminal club on the oral arm. Mitochondrial sequence data unambiguously delineate C. stuhlmanni as a separate species from C. orsini, and phylogenetic analyses support its placement within the monophyletic genus, Crambionella.
We present an initial report of a well-preserved and relatively diverse Gondwanan plant assemblage from Bahía Laura Group, Chon Aike Formation strata of the Estancia Flecha Negra area, central-western region of the Deseado Massif, Santa Cruz province, Patagonia, Argentina. The locality contains the first richly fossiliferous chert with a diverse and well-preserved plant assemblage reported from the Mesozoic which is demonstrably associated with hot spring activity. A compression flora and petrified forest contained in associated clastic and volcaniclastic environments provide an indication of regional plant diversity during this as yet poorly represented stratigraphic interval.
In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.
A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.
During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.
Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.
This study looks into different types of interactive functions, and
the associative relationship between these interactive functions and
website ranking. Six types of interactive functions are identified, and
four of them are found to be significant in affecting website ranking. The
four important types of interactive functions are Online Two-way
Communication, Customization, Content Variety, and Interactive Job
During experiments conducted within the vent pool of Medusa Geyser, Norris Geyser Basin, Yellowstone National Park, USA, amorphous opaline silica (opal-A) was deposited on/within plant tissues within 30 days of immersion. Initially, deposition created inter/intra-cellular films which lined cell walls plus intercellular colloid suspensions (sols) of opal-A nano/microspheres. By 330 days, opal-A deposition created a robust external and internal matrix that stabilised tissues against collapse and replicated plant structure. Opal-A films increased to micron-order thicknesses and intracellular sols were created. Systematic variation of opal-A fabric between tissues comprising living/dead cells at the time of deposition indicate that cell function, architecture and shape influence fabric development. Heterogeneity of opal-A fabric within adjacent cells of similar structure/function indicates spatially/temporally fluctuating physicochemical conditions and the presence of intraorganic microenvironments. Early deposition of opal-A films suggests a period of low silica supersaturation and slow opal-A deposition. In contrast, intracellular sols suggest high levels of supersaturation, and rapid opal-A deposition. Shell-like microsphere growth suggests cyclic variation of silica supersaturation, and alternations between rapid and slower opal-A deposition. Microsphere growth to the upper limit of colloidal stability and colloidal crystal structures indicate prolonged sol stability, whilst floc-like microsphere networks indicate localised sol instabi
Geoffrey T. Manley, Department of Neurological Surgery, University of California, San Francisco, CA,
Miki Fujimura, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
Tonghui Ma, Departments of Medicine and Physiology, Cardiovascular Research Institute, University of California, San Francisco, CA,
Ferda Filiz, Departments of Medicine and Physiology, Cardiovascular Research Institute, University of California, San Francisco, CA,
Andrew W. Bollen, Department of Pathology, University of California, San Francisco, CA,
Pak H. Chan, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
Alan S. Verkman, Departments of Medicine and Physiology, Cardiovascular Research Institute, University of California, San Francisco, CA
Abnormalities in brain water balance, such as edema and increased intracranial pressure, play an important role in the pathophysiology of acute head trauma, stroke and a variety of neurological disorders. However, little is known about the molecular mechanisms responsible for these alterations in cerebral water balance. Consequently, at present the therapeutic options are limited to neurosurgical decompression, intravenous administration of hyperosmolar agents and steroids, therapies that were introduced more than 40 years ago. There is recent evidence that molecular water channels called aquaporins, which have recently been identified in mammals, may play an important role in brain edema, thus offering therapeutic alternatives.
Aquaporins are small integral membrane proteins that function primarily as bidirectional water-selective transporters in many cell types in the kidney, lung and other fluid-transporting tissues where water flow is driven by osmotic gradients and hydrostatic pressure differences. The brain expresses at least two members of the aquaporin family in areas that are known to participate in the production and absorption of brain fluid. Aquaporin-1 is selectively expressed on the ventricular surface of choroid plexus epithelium where it may play a role in cerebrospinal fluid (CSF) production. Aquaporin-4 (AQP4) is abundantly expressed throughout the brain, particularly at the blood–brain and brain–CSF interfaces. AQP4 is expressed to a much lesser extent in tissue outside of the nervous system.
In October 1949 the CCP announced the foundation of the People's Republic of China. The next three years saw the high point of popular support for the new government, but the situation soon became more tense with the outbreak of the Korean war when the Chinese people were called on to ‘aid Korea and resist the US’ by means of voluntary military service, financial contributions and massive demonstrations. At the same time the CCP stepped up its efforts to revolutionize China: not content to rule, the communists intended to transform Chinese society. This entailed expropriation of the capitalist class and the creation of an egalitarian society through ideological campaigns, thought reform, public accusation meetings, mass arrests and intensive social control. All industries were nationalized by the mid-1950s and thereafter ran on command lines adopted from the Soviet Union, China's main ally. The state was effectively a one party system, with the theory of proletarian dictatorship as its ideological justification. There was undoubtedly repression, but also progress: China finally freed herself of foreign control, and standards of public health, education and welfare improved.
There were parallel developments in the countryside. By 1952 most land had been redistributed, in the following years it was collectivized and by 1958 People's Communes were set up over most of China. They remained in operation until the early 1980s, the evidence suggesting that they were inefficient as production units, although they did have a number of advantages over family farming:
The fate of Buddhism between 1949 and the start of the Cultural Revolution has been documented by Holmes Welch, to whose work the reader should refer. To summarize, in the early 1950s the CCP organized a new Buddhist organization known as the China Buddhist Association (CBA). As with the TSPM, its leaders were specifically chosen for their willingness to co-operate with the CCP; it was rumoured that some of them were underground Party agents. Understandably this caused resentment among other Buddhist leaders, who felt the new organization was unrepresentative and too politicized. Government agencies implemented a programme of control and consolidation of Party leadership in religious circles. Many monasteries had been important landholders, and subsidized their activities by income from rent and corvées. The loss of property in the land reforms of the early 1950s led to the collapse of their economic structure. Many monks returned to lay life, under pressure from cadres, through poverty, because their monasteries were closed, or through choice. Some were sent to labour camps, many were maltreated, others executed. Buddhist publications were obliged to change their contents to support the Party line rather than preach orthodox Buddhism. Lay believers were too frightened to visit temples. With increasing speed the whole Buddhist establishment crumbled.
By 1966 only a few monasteries survived: they had been kept alive that long only because the government used its ‘tolerance’ of Buddhism as a diplomatic tool when dealing with Asian neighbours such as Burma, and to keep Taiwan out of international organizations.