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To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.
Materials and methods
An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.
The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.
3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
Introduction: Most current cricothyroidotomy simulation models are either expensive or low fidelity and limit the learner to an unrealistic simulation experience. The goal of this project is to innovate current simulation techniques by 3D printing anatomically accurate trachea models. By doing so emergency cricothyroidotomy simulation can be accessible, high fidelity, cost effective and replicable. Methods: 3D modelling software was used in conjunction with a desktop 3D printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies measuring the dimensions of tracheal anatomy. This ensured an appropriate anatomical landmark design was achieved. Several revisions of the model were designed and qualitatively assessed by medical and simulation professionals to ensure anatomical accuracy that exceeded that of the currently used, low cost, cricothyroidotomy simulation model in St. John’s. Results: Using an entry level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in under 3 hours. Due to its anatomical accuracy, flexibility and durability, this model is ideal for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments and skin for appearance. Conclusion: The end result is a high fidelity simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically land marking, incision and intubation. This design is a novel, easy to manufacture, replicable, low fidelity trachea model that can be used by educators with limited resources such as those in rural and remote areas.
Chamorro-Premuzic, Winsborough, Sherman, and Hogan (2016) note that new talent signals recently adopted by organizations are related to older selection and assessment methods. Drawing this connection between old and new technologies is helpful; however, viewing new technology as either shiny new objects or a brave new world creates a false dichotomy. Recent technology-enhanced human resources (HR) processes like the widespread use of gamified practices and video-recorded interviewing are not just fads or the beginning of a transformation in HR but rather natural evolutions of methods that differ across specific dimensions that can be identified and measured. It is important to view these recent advances as extensions of the existing methods. That is, we need to focus on how these new methods are different and not on that they are different.
Herbicide applications often do not reach their full potential because only a small amount of the active ingredients reaches the intended targets. Selecting the appropriate application parameters and equipment can allow for improved efficacy. The objective of this research was to evaluate the effect of droplet size on efficacy of six commonly used herbicides. Atrazine (1.12 kg ai ha−1), cloransulam-methyl (0.18 g ai ha−1), dicamba (0.14 kg ae ha−1), glufosinate (0.59 kg ai ha−1), saflufenacil (12.48 g ai ha−1), and 2,4-D (0.20 kg ae ha−1) were applied to seven plant species using an XR11003 nozzle at 138, 276, and 414 kPa and a AI11003 nozzle at 207, 345, and 483 kPa. Each herbicide, nozzle, and pressure combination was evaluated for droplet size spectra. Treatments were applied at 131 L ha−1 to common lambsquarters, common sunflower, shattercane, soybean, tomato, velvetleaf, and volunteer corn. Control from 2,4-D was observed to increase approximately 12% on average for all species except common lambsquarters as droplet size increased from medium to very coarse (Dv0.5 303 to 462 μm; Dv0.5 is droplet size such that 50% of spray volume is contained in droplets of equal or smaller size). Control with atrazine was near 95% for common lambsquarters, common sunflower, and soybean. Atrazine provided the greatest shattercane control using a medium (Dv0.5 325 μm) droplet, whereas the same droplet size provided the lowest tomato control. Control of common lambsquarters, shattercane, and tomato with cloransulam-methyl increased 79% when decreasing droplet size from extremely coarse to fine (Dv0.5 637 to 228 μm). Dicamba control of common lambsquarters increased 17% using a medium droplet compared with a fine droplet (Dv0.5 279 to 204 μm). Dry weight of common sunflower and soybean was reduced 21% using dicamba when using a very coarse spray compared with a fine spray classification (Dv0.5 491 to 204 μm). Common lambsquarters control using glufosinate increased 18% using a fine spray classification (Dv0.5 186 μm) compared with medium (Dv0.5 250 μm) and both very coarse droplet sizes (Dv0.5 470 and 516 μm). Conversely, tomato and velvetleaf control with glufosinate was maximized using a very coarse (Dv0.5 470 and 516 μm) or extremely coarse droplet (Dv0.5 628 μm) with increases of 11 and 25% compared with a fine spray (Dv0.5 186 μm). Saflufenacil control of volunteer corn was 38% greater using extremely coarse droplets (Dv0.5 622 μm) than fine, medium, and very coarse spray classifications (Dv0.5 257 to 514 μm). Overall, spray classifications for the herbicides evaluated play an important role in herbicide efficacy and should be tailored to the herbicide being used and the targeted weed species.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
We describe bright microwave events that were first detected with the Parkes 64-m telescope at 8.4 or 22 GHz from six active-chromosphere stars. In some flares spectral data were obtained over a large frequency range from simultaneous measurements with the Parkes reflector (8.4 or 22 GHz), the Tidbinbilla interferometer (8.4 and 2.29 GHz), the Fleurs synthesis telescope (1.42 GHz) and the Molonglo Observatory synthesis telescope (0.843 GHz). Data on circular polarization were obtained from the Parkes observations at 8.4 GHz.
The stars were in a wide variety of evolutionary states, ranging from a single pre-main-sequence star (HD 36705), two RS CVn binaries (HD 127535, HD 128171), an Algol (HD 132742) and two apparently single K giants (HD 32918 and HD 196818). Their high brightness temperatures, positive spectral indices and low polarization are consistent with optically thick gyrosynchrotron emission from mildly relativistic electrons with average energies 0.5 to 3 MeV gyrating in inhomogeneous magnetic fields of 5 to 100 G.
Seeing measured in the open air with a differential image motion monitor (DIMM) is compared with seeing measured simultaneously at the Cassegrain focus of the Anglo-Australian Telescope (AAT). It is shown that when the mirror is hotter than the dome air, the AAT’s seeing is degraded by ~1 arcsec per Celsius degree of excess mirror temperature. The consequence of this is that mirror seeing currently contributes significantly to the seeing at the AAT on many nights. A mirror colder than the dome air does not seem to degrade seeing, and neither does an internal-to-external air temperature difference of up to at least 3°C when the venting fans are on.
To describe the current state of academic emergency medicine (EM) funding in Canada and develop recommendations to grow and establish sustainable funding.
A panel of eight leaders from different EM academic units was assembled. Using mixed methods (including a literature review, sharing of professional experiences, a survey of current EM academic heads, and data previously collected from an environmental scan), 10 recommendations were drafted and presented at an academic symposium. Attendee feedback was incorporated, and the second set of draft recommendations was further distributed to the Canadian Association Emergency Physicians (CAEP) Academic Section for additional comments before being finalized.
Recommendations were developed around the funding challenges identified and solutions developed by academic EM university-based units across Canada. A strategic plan was seen as integral to achieving strong funding of an EM unit, especially when it aligned with departmental and institutional priorities. A business plan, although occasionally overlooked, was deemed an important component for planning and sustaining the academic mission. A number of recommendations surrounding philanthropy consisted of creating partnerships with existing foundations and engaging multiple stakeholders and communities. Synergy between academic and clinical EM departments was also viewed as an opportunity to ensure integration of common missions. Education and networking for current and future leaders were also viewed as invaluable to ensure that opportunities are optimized through strong leadership development and shared experiences to further the EM academic missions across the country.
These recommendations were designed to improve the financial circumstances for many Canadian EM units. There is a considerable wealth of resources that can contribute to financial stability for an academic unit, and an annual networking meeting and continuing education on these issues will facilitate more rapid implementation of these recommendations.
Against a backdrop of increasing research, clinical and taxonomic attention in non-suicidal self-injury (NSSI), evidence suggests a link between NSSI and eating disorders (ED). The frequency estimates of NSSI in ED vary widely. Little is known about the sources of this variation, and no meta-analysis has quantified the association between ED and NSSI.
Using random-effects meta-analyses, meta-regression analyses, and 1816–6466 unique participants with various ED, we estimated the weighted average percentage of individuals with ED, those with anorexia nervosa (AN) and those with bulimia nervosa (BN) who are reported to have a lifetime history of NSSI across studies. We further examined predictors of NSSI in ED.
The weighted average percentage of patients with a lifetime history of NSSI was 27.3% [95% confidence interval (CI) 23.8–31.0%] for ED, 21.8% (95% CI 18.5–25.6%) for AN, and 32.7% (95% CI 26.9–39.1%) for BN. The difference between BN and AN was statistically significant [odds ratio (OR) 1.77, 95% CI 1.14–2.77, p = 0.013]. The odds of NSSI increased by 24% for every 10% increase in the percentage of participants with histories of suicide attempts (OR 1.24, 95% CI 1.04–1.48, p = 0.020) and decreased by 26% for every 10% increase in the percentage of participants with histories of substance abuse (OR 0.74, 95% CI 0.58–0.95, p = 0.023).
In the specific context of ED, NSSI is highly prevalent and correlates positively with attempted suicide, urging for NSSI-focused treatments. A novel finding is that NSSI is potentially antagonized by substance abuse.
We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.
We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.
We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.
The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
Congenital abnormalities of the coronary arteries in the absence of structural heart disease account for a small but interesting percentage of cardiac lesions in children. Their presentation may vary from incidental identification to aborted/sudden cardiac death. Patients with aborted sudden death episodes will require significant support if they develop extensive ischaemic myocardial injury. Ultimately, surgical repair should be carried out as soon as haemodynamic stability is attained and the neurological status is evaluated. The aims of this article were to provide a review of congenital abnormalities of the coronary arteries most commonly seen in children in the ICU as well as to review the current critical-care management thereof.
The past two decades have seen a significant advancement in the detection, classification and understanding of exoplanets and binary star systems. The vast majority of these systems consist of stars on the main sequence or on the giant branch, leading to a dearth of knowledge of properties at early times (<50 Myr). Only one transiting planet candidate and a dozen eclipsing binaries are known among pre-main sequence objects, yet these are the systems that can provide the best constraints on stellar and planetary formation models. We have recently completed a photometric survey of 3 young (<50 Myr), nearby (D<150 pc) moving groups with a small-aperture instrument, nicknamed “AggieCam”. We detected 7 candidate Hot Jupiters and over 200 likely pre-main sequence binaries, which are now being followed up photometrically and spectroscopically.