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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.
Graphene oxide (GO)/MnO2 nanocomposites were synthesized by adding KMnO4 in a solution of water and ethanol (3:1), containing 10 mg of GO. Brown precipitates were obtained after a continuous stirring for 1 hr. The precipitates were then washed with deionized water (DI) water and dried to obtain the MnO2-GO nanocomposites. Pure MnO2 was also synthesized using the same method without GO for the comparison. X-ray diffraction pattern confirm δ-MnO2 type of MnO2 with birnessite type MnO2 structure. The TEM images show the average diameter of MnO2 nanorods as 15 nm. Electrochemical characterizations were carried out in an aqueous solution of 3M KOH. Charge-discharge studies were carried out between 1A/g to 20 A/g current range. The MnO2-GO nanocomposites showed improved electrochemical performances. The capacitance of MnO2 and MnO2-GO electrodes was found to be as 300 F/g, and 350 F/g, respectively at a current of 0.5 A/g.
To assess the feasibility and acceptability of a beverage intervention in Hispanic adults.
Eligible individuals identified as Hispanic, were 18–64 years old and had BMI 30·0–50·0 kg/m2. Participants were randomized 2:2:1 to one of three beverages: Mediterranean lemonade (ML), green tea (GT) or flavoured water control (FW). After a 2-week washout period, participants were asked to consume 32 oz (946 ml) of study beverage daily for 6 weeks and avoid other sources of tea, citrus, juice and sweetened beverages; water was permissible. Fasting blood samples were collected at baseline and 8 weeks to assess primary and secondary efficacy outcomes.
Tucson, AZ, USA.
Fifty-two participants were recruited over 6 months; fifty were randomized (twenty-one ML, nineteen GT, ten FW). Study population mean (sd) age 44·6 (sd 10·2) years, BMI 35·9 (4·6) kg/m2; 78 % female.
Forty-four (88 %) completed the 8-week assessment. Self-reported adherence was high. No significant change (95 % CI) in total cholesterol (mg/dl) from baseline was shown −1·7 (−14·2, 10·9), −3·9 (−17·2, 9·4) and −13·2 (−30·2, 3·8) for ML, GT and FW, respectively. Mean change in HDL-cholesterol (mg/dl) −2·3 (−5·3, 0·7; ML), −1·0 (−4·2, 2·2; GT), −3·9 (−8·0, 0·2; FW) and LDL-cholesterol (mg/dl) 0·2 (−11·3, 11·8; ML), 0·5 (−11·4, 12·4; GT), −9·8 (−25·0, 5·4; FW) were also non-significant. Fasting glucose (mg/dl) increased significantly by 5·2 (2·6, 7·9; ML) and 3·3 (0·58, 6·4; GT). No significant change in HbA1c was demonstrated. Due to the small sample size, potential confounders and effect modifiers were not investigated.
Recruitment and retention figures indicate that a larger-scale trial is feasible; however, favourable changes in cardiometabolic biomarkers were not demonstrated.
The semi-colonial character of China during the treaty-port era brings into question the dichotomy between the colonizer and the colonized. China's foreign trade had an overall negative balance, and Great Britain, Japan, and the United States of America benefited from it. However, dozens of minor powers suffered a negative balance with China, despite the favourable conditions set in the treaty ports. This article examines the presence of Spain in China during the first decades of the twentieth century, focusing on trade, population, and issues of self-representation. Through a comparative analysis of the Sino-Spanish trade with that of other smaller powers in China, this article shows both the diversity of colonial formations in China and the existence of colonial relations that, although peripheral and complementary, pose a doubt on the adequacy, not only of the colonizer/colonized dichotomy, but also of the representation of colonialism in China.
This study is a dosimetric and acute toxicity comparison of endometrial cancer patients treated with either Axxent (Xoft, Inc., San José, CA, USA) electronic and interstitial brachytherapy versus interstitial high dose rate brachytherapy (HDRBT).
Materials and Methods
Between 2015 and 2017, 94 patients with postoperative endometrial cancer were treated in our centre with the Axxent electronic brachytherapy (eBT) system. The V150 and V200 are evaluated prospectively for each plan. The mean age of patients was 65.9 years (age range 33–84 years), with different tumour staging. Of the 94 patients, 37 received exclusive adjuvant brachytherapy (25 Gy in five sessions); the remaining patients received external beam radiotherapy (EBRT) with a regimen of 23 sessions of 2 Gy each to the entire pelvis, followed by eBT (15 Gy in three sessions). Additionally, the absorbed doses received by the organs at risk (OAR), urinary bladder, rectum and sigmoid colon were compared with HDRBT plans, evaluating D2cc, V50% and V35%. Median follow-up was done for each of the 94 patients to assess the toxicity of the treatment: vaginal mucosa toxicity, rectal and urinary toxicity; and results are presented for acute toxicity, toxicity at 1 month after the end of treatment and follow-up after 12 months for a portion of patients according to the Radiation Therapy Oncology Group (RTOG) toxicity criteria.
The doses in OAR for eBT plans were lower than that for HDRBT plans, both Ir-192 and Co-60 plans, whose doses were similar. The dose in bladder with eBT was 63.8% of the prescribed dose for D2cc versus 70.1% for HDRBT Ir-192, for V50% was 7.2% versus 12.7% and for V35% was 15.2% versus 28.2%. In rectum the D2cc was 61.2% versus 68.4%, for V50% was 7.9% versus 14.3% and for V35% was 16.7% versus 32%. Results demonstrated lower doses to OAR in all eBT plans. Acute toxicity in eBT was very low in cases of mucositis, with only one case of toxicity greater than grade 1, rectal toxicity and urinary toxicity; results at 1 month are equally good, toxicity symptoms disappeared and no relapses have occurred to date.
The results of treatment with the Axxent eBT unit for 94 patients are very good, as no recurrence has been observed and the toxicity of the treatment is very low. The increase in V150 and V200 has not produced an increase in vaginal mucosa toxicity, and the doses in the OAR are lower than in the plans implemented for HDRBT with Ir-192 or Co-60. eBT is a good alternative to treat endometrial cancer in centres without conventional HDR availability. To date, there are limited published studies reporting on outcomes from patients treated with eBT.
Mechanical properties similar to natural bone and good biocompatibility make magnesium a great option for its use as biodegradable implant material. The use of castings as fabrication technique brings inherent problems, such as segregation and void formation. Also, the architecture of the specimens created by using these techniques is limited. This study shows the implementation of WAAM for the fabrication of elements made out of AZ91D magnesium alloy (9% aluminium and 1% zinc). The results demonstrate that porosity or cracking only appears at the surface of the individual printed lines, while the central sections presents a void-less structure composed by an HCP magnesium matrix and a high density of well dispersed aluminium-zinc rich precipitates. EDS mapping confirms the presence of orthorhombic Al5Mg11Zn4 phase. Also, the relationship between the heat present in the system and the morphology of the lines is analysed.
Introduction: Over 2.6 million Hispanic/Latino construction workers (CWs) live in the US; 91% of South Florida CWs are Hispanic/Latino. CWs have higher smoking and lower cessation rates than other workers. Limited access to cessation services, worksite turnover, and lack of interventions tailored to culture/occupation hinder cessation. Partnering with worksite food trucks to deliver unique cessation interventions may improve these efforts.
Aims: To explore a novel cessation approach, assess worker/worksite acceptability, and seek input into intervention development.
Methods: In 2016, we conducted five semi-structured focus groups with 37 smoking Hispanic/Latino CWs. Constant comparative analysis was used to examine a priori themes regarding smoking behaviours, cessation treatments, intervention delivery, cultural adaptation, and quit interest.
Results: CWs reported tremendous job stress. Most smoking occurred during the workday and most CWs did not use nicotine replacement therapy with past quit attempts. Most CWs were open to a worksite face-to-face group cessation intervention before work (many underutilize breaks and feel pressure to keep working). CWs felt it unnecessary to tailor the intervention to Hispanics/Latinos indicating smokers are the same regardless of race/ethnicity.
Conclusions: Findings demonstrate the need to consider work environments, job demands/stress, and worker preferences when developing accessible and acceptable cessation interventions.
The present study aimed to identify predictors of one aspect of sign language acquisition, sign learning, in hearing nonsigners. Candidate predictors were selected based on the theory that the observed relationship between phonological short-term memory and L2 lexical learning is due in part to common perceptual-motor processes. Hearing nonsigning adults completed a sign learning task, three assessments of short-term memory for movements (movement STM; two of which used sign-like stimuli), and two visuospatial STM tasks. The final sample included 103 adults, ranging between 18 and 33 years of age. All predictors were moderately to strongly correlated with the sign learning task and to each other. A series of regression analyses revealed that both movement and visuospatial STM uniquely contributed to the prediction of sign learning. These results suggest that perceptual-motor processes play a significant role in sign learning and raise questions about the role of phonological processing.
In this review article, we discuss selected developments regarding the role of the equation of state in simulations of core-collapse supernovae. There are no first-principle calculations of the state of matter under supernova conditions since a wide range of conditions is covered, in terms of density, temperature, and isospin asymmetry. Instead, model equation of state are commonly employed in supernova studies. These can be divided into regimes with intrinsically different degrees of freedom: heavy nuclei at low temperatures, inhomogeneous nuclear matter where light and heavy nuclei coexist together with unbound nucleons, and the transition to homogeneous matter at high densities and temperatures. In this article, we discuss each of these phases with particular view on their role in supernova simulations.
Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density (‘protein leverage’). According to the ‘protein leverage hypothesis’ (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy.
National representative cross-sectional study.
National Health and Nutrition Examination Survey 2009–2010.
Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data.
We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant.
The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.
Are interactions between soldiers, politicians, and civilians improving? Every nation has to come to grips with achieving a more enduring harmony between government, the armed forces, and society if it aspires to strengthen its democracy. While there is an abundance of studies on civil-military affairs, few examine all three of these actors, let alone establish any standards with which to assess whether progress is being made. This ambitious book devises a novel framework equipped with six dimensions, each of which opens a unique window into civil-military affairs, and which form a more integrated view of the subject. Those dimensions are accompanied by a set of benchmarks and metrics that assess progress and compare one country against another. The framework is applied to case studies of Argentina, Brazil, Chile, and Uruguay, with the conviction that insights could be gleaned that may be relevant elsewhere. Ultimately, by unpacking the civil-military relation into its various dimensions, this study has shed light on what it takes to transform what was once a politically-minded military into an organization dedicated to serving a democratic state and society.