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We sought to retrospectively report our outcomes using post-operative stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) in place of whole-brain radiation therapy (WBRT) following resection of brain metastases from our hospital-based community practice.
Materials and Methods:
A retrospective review of 23 patients who underwent post-operative SRS at our single institution from 2013 to 2017 was undertaken. Patient records, treatment plans and diagnostic images were reviewed. Local failure, distant intracranial failure and overall survival were studied. Categorical variables were analyzed using Fisher’s exact tests. Continuous variables were analyzed using Mann–Whitney tests. The Kaplan–Meier method was used to estimate survival times.
16 (70%) were single-fraction SRS, whereas the remaining 7 patients received a five-fraction treatment course. The median single-fraction dose was 16 Gy (range, 16–18). The median total dose for fractionated treatments was 25 Gy (range, 25–35). Overall survival at 6 and 12 months was 95 and 67%, respectively. Comparison of SRS versus SRT local control rates at 6 and 12 months revealed control rates of 92 and 78% versus 29 and 14%, respectively. Every patient with dural/pial involvement at the time of surgery had distant intracranial failure at the 12-month follow-up.
Single-fraction frameless SRS proved to be an effective modality with excellent local control rates. However, the five-fraction SRT course was associated with an increased rate of local recurrence. Dural/pial involvement may portend a high risk for distant intracranial disease; therefore, it may be prudent to consider alternative approaches in these cases.
We examined risk factors associated with the intestinal acquisition of antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) and development of community-acquired urinary tract infection (UTI) in a case-control study of young women across Canada. A total of 399 women were recruited; 164 women had a UTI caused by E. coli resistant to ⩾1 antimicrobial classes and 98 had a UTI caused by E. coli resistant to ⩾3 antimicrobial classes. After adjustment for age, student health service (region of Canada) and either prior antibiotic use or UTI history, consumption of processed or ground chicken, cooked or raw shellfish, street foods and any organic fruit; as well as, contact with chickens, dogs and pet treats; and travel to Asia, were associated with an increased risk of UTI caused by antimicrobial resistant E. coli. A decreased risk of antimicrobial resistant UTI was associated with consumption of apples, nectarines, peppers, fresh herbs, peanuts and cooked beef. Drug-resistant UTI linked to foodborne and environmental exposures may be a significant public health concern and understanding the risk factors for intestinal acquisition of existing or newly emerging lineages of drug-resistant ExPEC is important for epidemiology, antimicrobial stewardship and prevention efforts.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
We have developed a system, called SKICAT, for producing, managing and analyzing catalogs from the digitized POSS-II survey. The system classifies and matches catalogs from multiple, overlapping plate scans as well as CCD calibration sequences; and it can be used for the scientific analysis of the resulting catalogs. It incorporates a number of novel machine-learning and AI tools, including the star/galaxy classification using decision tree algorithms. This results in star/galaxy separation accurate to 90% or better down to BJ ∼ 21m, i.e. ∼ 1m above the plate limit The final catalog is expected to contain at least 5 × 107 galaxies and > 2 × 109 stars. We present preliminary results on galaxy counts from a test region near the NGP. We find a mild excess over the no-evolution models, smaller than previously found by the APM group. A search for z > 4 quasars and the two-point correlation analysis of this data set are in progress.
We present routine methods of target preparation for radiocarbon analysis at the ANTARES Accelerator Mass Spectrometry (AMS) Centre, as well as recent developments which have decreased our procedural blank level and improved our ability to process small samples containing less than 200 μg of carbon. Routine methods of 14C sample preparation include sample pretreatment, CO2 extraction (combustion, hydrolysis and water stripping) and conversion to graphite (graphitization). A new method of cleaning glassware and reagents used in sample processing, by baking them under a stream of oxygen, is described. The results show significant improvements in our procedural blanks. In addition, a new graphitization system dedicated to small samples, using H2/Fe reduction of CO2, has been commissioned. The technical details of this system, the graphite yield and the level of fractionation of the targets are discussed.
Studying the cool atomic phase of the interstellar medium is of special significance as cool atomic clouds can become the raw material for star formation and so determine the evolution of the whole galaxy. The cool atomic interstellar medium of the Large Magellanic Cloud (LMC) seems to be quite different from that in the Milky Way. In three 21 cm absorption line surveys using the Australia Telescope Compact Array (ATCA) the physical properties of the cool atomic hydrogen in the LMC and the halo of the Magellanic Clouds have been studied. Here we present the results of the third HI absorption line survey. A detailed investigation of the cool HI has been done toward the supergiant shell LMC4, the surroundings of 30 Doradus and in the direction of the eastern steep HI boundary. The data have been compared with survey 2 (Dickey et al. 1994) to probe the cool gas fraction for these different regions of the LMC and to study the differences of the cool atomic phase of the LMC and that of the Milky Way.
Plant growth and insect resistance characteristics were determined for two Brassica napus Linnaeus (Brassicaceae) lines, AtGL3+ and K-5-8, developed for enhanced trichome densities relative to their parental cultivar Westar. In the field, both transgenic lines had glabrous cotyledons that curled upwards at emergence but flattened with time, and young leaves with elevated trichome density. Flea beetle (Phyllotreta cruciferae (Goeze) and Phyllotreta striolata (Fabricius); Coleoptera: Chrysomelidae) feeding was reduced on true leaves of both lines by 30–50% compared with insecticide-free Westar. Flea beetle feeding levels on cotyledons of the two hairy-leaved lines were lower than on unprotected Westar and similar to those seen on insecticide-treated Westar. Antixenosis and antibiosis resistance was observed when diamondback moths (Plutella xylostella (Linnaeus); Lepidoptera: Plutellidae) interacted with the hairy AtGL3+ and K-5-8 lines in the laboratory. Although the numbers of eggs laid by female diamondback moths on the transformed lines were similar to or higher than on Westar, in feeding bioassays larvae moved off AtGL3+ plants and larval feeding injury decreased on the transformed lines compared with Westar leaves. No agronomic or seed yield penalties were found for plants of K-5-8. These data highlight the utility of manipulating trichome regulatory genes to increase plant resistance against brassicaceous insect pests.
In recognition of its special interdisciplinary character, IAU Commission 14 is linked directly to the Executive Committee. The Commission’s role is to inform the astronomical community of new developments in the diverse fields of research which involve atoms and molecules. Conversely it endeavors to sensitize the research community active in those fields to the specific needs of astronomy, especially concerning basic data and modeling tools. More generally, Commission 14 tries to foster long term relations and collaborations between the two communities and, when necessary, to alert funding authorities to the specific needs of ground and space based astronomy for specific atomic and molecular data. This report is one of the main contributions of Commission 14 to the information of the astronomical community. Several meetings concerned, at least in part, with the need and availability of atomic and molecular data for astrophysics were also sponsored or co-sponsored. In the last triennium, Commission 14 cosponsored IAU Symposium 194 “Astrochemistry: From Molecular Cloud to Planetary Systems” held in Sogwipo (Korea) from Aug. 23 to 27, 1999 and organized by Commission 34. A Joint Discussion: JD1 on “Atomic and Molecular Data for Astrophysics, New Developments, Case Studies and Future Needs” has been planned for the XXIVth IAU General Assembly in Manchester (Aug. 7-19, 2000) and cosponsored by Commissions 15, 16, 29, 34, 36, 40 and 44. Several other Joint Discussions to be held at the Manchester General Assembly are co-sponsored by this commission.
For almost two decades, O'Brien and colleagues have investigated virtually every facet of dementia with Lewy bodies (DLB), phenomenology, treatment, and neurobiology, ranging from genetics to post-mortem and in vivo imaging studies. The latest study from this group, reported here, describes differences in regional grey matter volumes using magnetic resonance (MR) imaging and an automated segmentation analysis method in a well-characterized sample of patients with Alzheimer disease (AD), DLB, and a healthy control group (Watson et al., 2015). The study incorporated detailed psychometric assessments of cognitive and motor functions for correlation with the grey matter volumes, and age, gender and dementia severity were included as covariates in the statistical analysis. The key observations are relatively greater hippocampal volumes and lower subcortical volumes in DLB compared to AD, but it is to be noted that most of these differences in subcortical volume were demonstrated indirectly through comparisons of the disease groups with age-matched healthy control subjects. Thus, replication in studies that make direct comparisons between DLB and AD subjects, perhaps in a larger sample size, is necessary. Still, these results highlight the potential for MR imaging to provide indicators of the extent of the neurodegenerative process in DLB. Furthermore, the results underscore the importance of correcting molecular imaging data for the effects of cerebral atrophy (partial volume correction) that may further enhance the ability of these methods to reveal pathophysiological processes.
Clostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA.
We constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed.
Base-case analysis showed that FMT was less costly ($1,669 vs $3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <$3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations.
Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.
Spinal cord injury (SCI) is a serious condition that may lead to long-term disabilities placing financial and social burden on patients and their families, as well as their communities. Spinal immobilization has been considered the standard prehospital care for suspected SCI patients. However, there is a lack of consensus on its beneficial impact on patients’ outcome.
This paper reviews the current literature on the epidemiology of traumatic SCI and the practice of prehospital spinal immobilization.
A search of literature was undertaken utilizing the online databases Ovid Medline, PubMed, CINAHL, and the Cochrane Library. The search included English language publications from January 2000 through November 2012.
The reported annual incidence of SCI ranges from 12.7 to 52.2 per 1 million and occurs more commonly among males than females. Motor vehicle collisions (MVCs) are the major reported causes of traumatic SCI among young and middle-aged patients, and falls are the major reported causes among patients older than 55. There is little evidence regarding the relationship between prehospital spinal immobilization and patient neurological outcomes. However, early patient transfer (8-24 hours) to spinal care units and effective resuscitation have been demonstrated to lead to better neurological outcomes.
This review reaffirms the need for further research to validate the advantages, disadvantages, and the effects of spinal immobilization on patients’ neurological outcomes.
OteirAO, SmithK, JenningsPA, StoelwinderJU. The Prehospital Management of Suspected Spinal Cord Injury: An Update. Prehosp Disaster Med. 2014;29(4):1-4.
The future of centimetre and metre-wave astronomy lies with the Square Kilometre Array (SKA), a telescope under development by a consortium of 17 countries that will be 50 times more sensitive than any existing radio facility. Most of the key science for the SKA will be addressed through large-area imaging of the Universe at frequencies from a few hundred MHz to a few GHz. The Australian SKA Pathfinder (ASKAP) is a technology demonstrator aimed in the mid-frequency range, and achieves instantaneous wide-area imaging through the development and deployment of phased-array feed systems on parabolic reflectors. The large field-of-view makes ASKAP an unprecedented synoptic telescope that will make substantial advances in SKA key science. ASKAP will be located at the Murchison Radio Observatory in inland Western Australia, one of the most radio-quiet locations on the Earth and one of two sites selected by the international community as a potential location for the SKA. In this paper, we outline an ambitious science program for ASKAP, examining key science such as understanding the evolution, formation and population of galaxies including our own, understanding the magnetic Universe, revealing the transient radio sky and searching for gravitational waves.
Investigation of optical absorption in ∼25μm thick, monocrystalline silicon (Si) substrates obtained from a novel exfoliation technique is done by fabricating solar cells with single heterojunction architecture (without using intrinsic amorphous silicon layer) with diffused back junction and local back contact. The ease of process flow and the rugged and flexible nature of the substrates due to thick metal backing enables use of various light-trapping and optical absorption enhancement schemes traditionally practiced in the industry for thicker (>120μm) substrates. Optical measurement of solar cells using antireflective coating, texturing on both surfaces, and back surface dielectric/metal stack as mirror to reflect the long wavelength light from the back surface show a very low front surface reflectance of 4.6% in the broadband spectrum (300nm-1200nm). The illuminated current voltage (IV) and external quantum efficiency (EQE) measurement of such solar cell shows a high integrated current density of 34.4mA/cm2, which implies significant internal photon reflection. Our best cell with intrinsic amorphous silicon (i-a-Si) layer with only rear surface textured shows an efficiency of 14.9%. EQE data shows improved blue response and current density due to better front surface passivation. Simulations suggest that with optimized light trapping and surface passivation, such thin c-Si cells can reach efficiencies >20%.
Epitaixal Ba0.5Sr0.5TiO3 (BST) thin films were grown on SrTiO3 (STO) and DyScO3 substrates by radio-frequency magnetron sputtering system using three-step method which involves a relatively low-temperature (573-773 K) growth of a BST interlayer sandwiched between two BST layers deposited at a high substrate temperature of 1068 K. X-ray diffraction measurement showed different strains on the films with interlayers grown at different temperatures. Post-growth thermal treatment reduced film strain to a great extent (the film strain of a tri-layer film with a 773 K grown interlayer is only -0.001). Comparing with the control films grown at high temperature, three-step technique improved the dielectric properties, especially increased dielectric constant by 60% for BST/STO and 31% for BST/DyScO3, respectively. High dielectric constant of 1631.4 and its tuning of 36.7% were achieved on the BST/STO with an interlayer grown on 773 K.
The joint Nagra/JNC Radionuclide Retardation Programme has now been ongoing for 15 years with the main aim of direct testing of radionuclide transport models in as realistic a manner as possible. A large programme of field, laboratory and natural analogue studies has been carried out at the Grimsel Test Site in the central Swiss Alps and the Kamaishi In Situ Test Site in north-east Japan. The understanding and modelling of both the processes and the structures influencing radionuclide transport/retardation in fractured host rocks have matured as has the experimental technology, which has contributed to develop confidence in the applicability of the underlying research models in a repository performance assessment. In this paper, the successes and set-backs of this programme are discussed as is the general approach to the thorough testing of the process models and of model assumptions. In addition, a set of key findings is presented, involving discussions on the enhancement of confidence through the program.
Polystannanes, i.e. organometallic polymers of the chemical formula (SnR2)n, are relatively little explored, although they belong to the rare examples of polymers which are characterized by a backbone of metal atoms which are linked by covalent bonds. We developed a new synthetic route which yields pure linear poly(dibutylstannane) [Sn(Bu)2]n by polymerization of dibutylstannane (dibutyltin dihydride) with the catalyst [RhCl(PPh3)3]. Here, we report that the conversion and the reaction rate of dibutylstannane depends crucially on the temperature and [RhCl(PPh3)3] is also suited for the polymerization of dioctylstannane and didodecylstannane. The polymers thus obtained were characterized by 1H, 13C and 119Sn NMR spectroscopy: Orientation of all polystannanes was achieved by tensile drawing. The orientation was examined by UV-vis spectroscopy with polarized light and X-ray diffraction. Remarkably, the orientation of the backbone depended on the length of the alkyl groups.
The effects of segregation of tramp impurities such as sulfur on metal/ceramic bonding is discussed. Microstructural and chemical information is given for the Fe/sapphire interface. The segregation behavior of the interface is evaluated between 500–800 °C. The interfacial structure is shown to be important to the segregation behavior. A possible link between the segregation of sulfur and interface void formation is presented.
The epitaxy of CaF2 on Si(111) is characterized on an atomic scale using various photoelectron spectroscopy techniques. We find both F and Ca bonding to Si with Ca forming most of the interface bonds. The bonding orbital is found at 1.5 eV below the valence band maximum of Si. It consists of the Si3p-like dangling bond orbital and the 4s electron of Ca1+. Ca has changed its oxidation state at the interface from Ca2+ to Ca1+, which is demonstrated by the multiplet structure of the Ca 2p absorption edge. The electronic properties of the CaF2 interface layer are altered dramatically relative to bulk material, with the band gap shrinking from 12 eV to about 2 eV. Such strong effects raise prospects for creating new materials in the vicinity of an interface.