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The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.
Methods and materials:
Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.
Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.
The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.
BACTOT, Quebec’s healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework.
A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non–catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2–10 of surveillance relative to year 1.
Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12–5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2–10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%–89%) higher than the first year rate.
HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.
Wearable devices are fast evolving to address mobility and autonomy needs of elderly people who would benefit from physical assistance. Recent developments in soft robotics provide important opportunities to develop soft exoskeletons (also called exosuits) to enable both physical assistance and improved usability and acceptance for users. The XoSoft EU project has developed a modular soft lower limb exoskeleton to assist people with low mobility impairments. In this paper, we present the design of a soft modular lower limb exoskeleton to improve person’s mobility, contributing to independence and enhancing quality of life. The novelty of this work is the integration of quasi-passive elements in a soft exoskeleton. The exoskeleton provides mechanical assistance for subjects with low mobility impairments reducing energy requirements between 10% and 20%. Investigation of different control strategies based on gait segmentation and actuation elements is presented. A first hip–knee unilateral prototype is described, developed, and its performance assessed on a post-stroke patient for straight walking. The study presents an analysis of the human–exoskeleton energy patterns by way of the task-based biological power generation. The resultant assistance, in terms of power, was 10.9% ± 2.2% for hip actuation and 9.3% ± 3.5% for knee actuation. The control strategy improved the gait and postural patterns by increasing joint angles and foot clearance at specific phases of the walking cycle.
Through a panel analysis conducted in Bavaria, which covers two adjacent elections – the federal elections and the European elections in 2013 and 2014 – we examine the attitudinal factors that drive citizens’ propensity to turn out. We find that abstainers have generally low levels of knowledge, interest and sense of civic duty. National-level voters have relatively high interest, knowledge and sense of duty in national politics, but not in European affairs. In contrast, European- and national-level voters have high interest, knowledge and a sense of duty for both national and European politics. This finding contextualizes the characterization of European elections as second-order national elections. While prior research has established that voters make their vote choice based on national-level politics, we demonstrate that European elections are not national elections when it comes to citizens’ decision to vote. Rather, knowledge, interest and a sense of duty about national politics are not sufficient conditions for somebody to vote in the European elections. The person needs to have the same positive attitudes about European affairs as they have about national politics to participate in European elections.
Bedrock mortars recur in the record of many prehispanic communities. However, few studies discuss their relationship with social processes. In the present work, we discuss a regional study of bedrock mortars in the semiarid north of Chile, specifically the Limarí River basin (30° S). Using a combination of formal, spatial, contextual, archaeobotanical, and absolute dating analyses, we assess the chronology of bedrock mortars and how they related to social processes of hunter-gatherer populations of the region (2000 BC to AD 1000). In particular, we suggest that an increase in production of bedrock mortars among pottery-using hunter-gatherer groups (AD 1–1000) can be observed, associated with a greater intensity of plant collection and use, and a diminution in the importance of hunting. This situation led to a set of new social relationships structured on the practice of collective grinding and shared use of bedrock mortars. These results show the importance of this material record as a means of approaching aspects of prehispanic social life, and demonstrates a methodological framework within which to interrogate this materiality by combining different analytical levels of bedrock mortars’ variability.
Healthcare-associated bloodstream infections (HABSI) are a significant cause of morbidity and mortality worldwide. In Québec, Canada, HABSI arising from acute-care hospitals have been monitored since April 2007 through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program, but this is the first detailed description of HABSI epidemiology.
This retrospective, descriptive study was conducted using BACTOT surveillance data from hospitals that participated continuously between April 1, 2007, and March 31, 2017. HABSI cases and rates were stratified by hospital type and/or infection source. Temporal trends of rates were analyzed by fitting generalized estimating equation Poisson models, and they were stratified by infection source.
For 40 hospitals, 13,024 HABSI cases and 23,313,959 patient days were recorded, for an overall rate of 5.59 per 10,000 patient days (95% CI, 5.54–5.63). The most common infection sources were catheter-associated BSIs (23.0%), BSIs secondary to a urinary focus (21.5%), and non–catheter-associated primary BSIs (18.1%). Teaching hospitals and nonteaching hospitals with ICUs often had rates higher than nonteaching hospitals without ICUs. Annual HABSI rates did not exhibit statistically significant changes from year to year. Non–catheter-associated primary BSIs were the only HABSI type that exhibited a sustained change across the 10 years, increasing from 0.69 per 10,000 patient days (95% CI, 0.59–0.80) in 2007–2008 to 1.42 per 10,000 patient days (95% CI, 1.27–1.58) in 2016–2017.
Despite ongoing surveillance, overall HABSI rates have not decreased. The effect of BACTOT participation should be more closely investigated, and targeted interventions along alternative surveillance modalities should be considered, prioritizing high-burden and potentially preventable BSI types.
Features of the turbulent cascade are investigated for various datasets from three different turbulent flows, namely free jets as well as wake flows of a regular grid and a cylinder. The analysis is focused on the question as to whether fully developed turbulent flows show universal small-scale features. Two approaches are used to answer this question. First, two-point statistics, namely structure functions of longitudinal velocity increments, and, second, joint multiscale statistics of these velocity increments are analysed. The joint multiscale characterisation encompasses the whole cascade in one joint probability density function. On the basis of the datasets, evidence of the Markov property for the turbulent cascade is shown, which corresponds to a three-point closure that reduces the joint multiscale statistics to simple conditional probability density functions (cPDFs). The cPDFs are described by the Fokker–Planck equation in scale and its Kramers–Moyal coefficients (KMCs). The KMCs are obtained by a self-consistent optimisation procedure from the measured data and result in a Fokker–Planck equation for each dataset. Knowledge of these stochastic cascade equations enables one to make use of the concepts of non-equilibrium thermodynamics and thus to determine the entropy production along individual cascade trajectories. In addition to this new concept, it is shown that the local entropy production is nearly perfectly balanced for all datasets by the integral fluctuation theorem (IFT). Thus, the validity of the IFT can be taken as a new law of the turbulent cascade and at the same time independently confirms that the physics of the turbulent cascade is a memoryless Markov process in scale. The IFT is taken as a new tool to prove the optimal functional form of the Fokker–Planck equations and subsequently to investigate the question of universality of small-scale turbulence in the datasets. The results of our analysis show that the turbulent cascade contains universal and non-universal features. We identify small-scale intermittency as a universality breaking feature. We conclude that specific turbulent flows have their own particular multiscale cascades, in other words, their own stochastic fingerprints.
The bird-infecting acanthocephalan Polymorphus minutus has been suggested to comprise different lineages or even cryptic species using different intermediate hosts. To clarify this open question, we investigated Polymorphus cf. minutus cystacanths originating from amphipod intermediate hosts from 27 sites in Germany and France. Parasites and hosts were identified using integrated datasets (COI and/or morphology for hosts and COI + ITS1-5.8S-ITS2 for parasites).
Mitochondrial and nuclear data (ITS1) strongly support the existence of three cryptic species in Polymorphus cf. minutus (type 1-3). These three types reveal a high degree of intermediate host specificity, with Polymorphus type 1 only encountered in Gammarus fossarum type B, Polymorphus type 2 in Echinogammarus sp. and Echinogammarus berilloni, and Polymorphus type 3 in Gammarus pulex and Gammarus roeselii. Our results point to a so far neglected cryptic diversity of the genus Polymorphus in Central Europe. Furthermore, Polymorphus type 2 is most likely a non-native parasite in Germany that co-invaded with E. berilloni from the Mediterranean area. Potentially, type 3 originates from South-East Europe and migrated to Germany by G. roeselii, where it might have captured G. pulex as an intermediate host. Therefore, our findings can be seen in the context of ecological globalization in terms of the anthropogenic displacement of intermediate hosts and its impact on the genetic divergence of the parasites.
The study of orthographic errors in a transparent language such as Spanish is an important topic in relation to writing acquisition because in Spanish it is common to write pseudohomophones as valid words. The main objective of the present study was to explore the possible differences in activation patterns in brain areas while processing pseudohomophone orthographic errors between participants with high (High Spelling Skills (HSS)) and low (Low Spelling Skills (LSS)) spelling orthographic abilities. We hypothesize that (a) the detection of orthographic errors will activate bilateral inferior frontal gyri, and that (b) this effect will be greater in the HSS group. Two groups of 12 Mexican participants, each matched by age, were formed based on their results in a group of spelling-related ad hoc tests: HSS and LSS groups. During the fMRI session, two experimental tasks were applied involving correct and pseudohomophone substitution of Spanish words. First, a spelling recognition task and second a letter searching task. The LSS group showed, as expected, a lower number of correct responses (F(1, 21) = 52.72, p <.001, η2 = .715) and higher reaction times compared to the HSS group for the spelling task (F(1, 21) = 60.03, p <.001, η2 = .741). However, this pattern was reversed when the participants were asked to decide on the presence of a vowel in the words, regardless of spelling. The fMRI data showed an engagement of the right inferior frontal gyrus in HSS group during the spelling task. However, temporal, frontal, and subcortical brain regions of the LSS group were activated during the same task.
Evaluating the occurrence of diseases in aquatic mustelids is a priority in the conservation strategies for the Neotropical river otter and giant otter. Thus, the objective of this study was to determine the frequency of infection caused by Cryptosporidium spp. and Giardia sp. in both host species in northern Brazil. The collection of biological samples was carried out in the states of Amapá, Amazonas, Pará and Rondônia, totalling 337 faecal samples of these species, which were processed using Kinyoun's technique for the identification of Cryptosporidium spp. oocysts, and centrifugal flotation in zinc sulphate solution for visualization of Giardia sp. cysts. All samples were also tested by direct immunofluorescence. The frequency of infection by Cryptosporidium spp. was higher than Giardia sp., in the two otter species. In the analysed samples co-infection by both protozoa was also found in 4.47% (14/313) of Neotropical river otter and 20.83% (5/24) of giant otter samples. Oocysts and cysts of Cryptosporidium and Giardia, respectively, may remain infectious within specific environmental conditions for long periods of time. The current identification of Neotropical and giant otters as hosts of these protozoa increases the possibility of infection in this species and the transmission of those agents to other aquatic and terrestrial organisms, as well as to human populations. The findings of this study represent the first description of Cryptosporidium spp. and Giardia sp. affecting Lontra longicaudis and Pteronura brasiliensis.
Post-Asymptotic giant branch (post-ABG) sources with high-velocity spectral features of H2O maser emission detected toward their circumstellar envelopes (CSEs) are known as Water Fountain (WF) nebulae. These are low- or intermediate-mass Galactic stellar sources that are undergoing the late stages of an intense mass-loss process. The velocity and the spatial distribution of the H2O maser spectral features can provide information about the kinematics of the molecular gas component of their CSEs. Hence, observational studies toward WF nebulae could help to better understand the formation of the asymmetric structures (hundred to thousand AUs) commonly seen toward Planetary nebulae (PNe). Here we present preliminary results of observations done toward the WF IRAS 15445-5449 using the Australia Telescope Compact Array (ATCA) and the Very Large Telescope (SINFONI/VLT). Assuming that the pumping of the H2O maser transitions is a consequence of shocks between different velocity winds, the spatial distribution of the emission shed light on the scales of the regions affected by the propagation of the shock-fronts.
We present the results of the first detection of submillimeter water maser emission toward water-fountain nebulae. Using APEX we found emission at 321.226 GHz toward two sources: IRAS 18043−2116, and IRAS 18286−0959. The submillimeter H2O masers exhibit expansion velocities larger than those of the OH masers, suggesting that these masers, similarly to the 22 GHz masers, originate in fast bipolar outflows. The 321 GHz masers in IRAS 18043−2116 and IRAS 18286−0959, which figure among the sources with the fastest H2O masers, span a velocity range similar to that of the 22 GHz masers, indicating that they probably coexist. The intensity of the submillimeter masers is comparable to the 22 GHz masers, implying that the kinetic temperature of the region where the masers originate is Tk>1000 K. We propose a simple model invoking the passage of two shocks through the same gas that creates the conditions for explaining the strong high-velocity 321 GHz masers coexisting with the 22 GHz masers in the same region.
A few studies have recently reported that higher cardiorespiratory fitness is associated with higher volumes of subcortical brain structures in children. It is, however, unknown how different fitness measures relate to shapes of subcortical brain nuclei. We aimed to examine the association of the main health-related physical fitness components with shapes of subcortical brain structures in a sample of forty-four Spanish children aged 9·7 (sd 0·2) years from the NUtraceuticals for a HEALthier life project. Cardiorespiratory fitness, muscular strength and speed agility were assessed using valid and reliable tests (ALPHA-fitness test battery). Shape of the subcortical brain structures was assessed by MRI, and its relationship with fitness was examined after controlling for a set of potential confounders using a partial correlation permutation approach. Our results showed that all physical fitness components studied were significantly related to the shapes of subcortical brain nuclei. These associations were both positive and negative, indicating that a higher level of fitness in childhood is related to both expansions and contractions in certain regions of the accumbens, amygdala, caudate, hippocampus, pallidum, putamen and thalamus. Cardiorespiratory fitness was mainly associated with expansions, whereas handgrip was mostly associated with contractions in the structures studied. Future randomised-controlled trials will confirm or contrast our findings, demonstrating whether changes in fitness modify the shapes of brain structures and the extent to which those changes influence cognitive function.
Despite renewed efforts to better understand glacier change and recognize glacier change trends in the Andes, relatively large areas in the Andes of Argentina and Chile are still not investigated. In this study, we report on glacier elevation and mass changes in the outer region of the Northern and Southern Patagonian Icefields in the Southern Patagonian Andes. A newly-compiled Landsat ETM+ derived glacier inventory (consisting of 2253 glaciers and ~1314 ± 66 km2 of ice area) and differencing of the SRTM and SPOT5 DEMs were used to derive glacier-specific elevation changes over the 2000–12 period. The investigated glaciers showed a volume change of −0.71 ± 0.55 km3 a−1, yielding a surface lowering of 0.52 ± 0.35 m a−1 on average and an overall mass loss of 0.46 ± 0.37 m w.e. a−1. Highly variable individual glacier responses were observed and interestingly, they were less negative than previously reported for the neighboring Patagonian Icefields.
Drawing on the work of Richard Simeon and using the cases of equalization in Canada and Belgium's social security system, this article shows how nationalist ideas combined with institutional management structures, government formation rules and the configuration of party systems to condition the territorial dynamics around these two programmes. In Canada, resentment against equalization in many provinces, often because it is perceived as accommodating Québécois nationalism, has translated only into moderate pressures on the programme because federal parties have largely stayed away from this divisive issue and federal executive discretion over the programme has meant that provinces cannot force change. In Belgium, pressures on social security have been more intense because the absence of pan-Belgian parties has given greater resonance to Flemish nationalist ideas within the political system.