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In this paper, an antenna with 8 GHz (7–15 GHz) bandwidth is designed, simulated, fabricated, and measured. Commonly, for the effective use of electromagnetic sources, mode converters are used to transform donut-shaped patterns to directive patterns. This paper introduces a novel antenna called the pattern director antenna (PDA) that solves most problems associated with the azimuthally symmetric output modes of high-power microwave sources. The PDA accepts directly (without the need for mode conversion) an azimuthally symmetric generated mode of an electromagnetic source and converts it to radiate a directive pattern. For the proof of concept and validation of the design by simulations, the 3D printing technology [using polylactic acid (PLA)] is used to fabricate the PDA and measure its radiation patterns and return loss. The selected material is cheap and also environmentally friendly. The antenna was coated with aluminum to become a conductor. The gain is from 16.8 to 21.8 dB in the frequency range. The S11, main lobe deviation (MLD), and sidelobe level (SLL) are less than −15 dB, 2°, and −7 dB, in all frequency range, respectively. The simulation results are in good agreement with the measurement.
The audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.
The BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.
4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.
CAMHS services referred 1/16 patients.
Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.
8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.
Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.
Patients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.
Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.
Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.
This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.
Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak.
Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS.
The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student’s worry regarding their studies/graduation. Perceived stress was decreased if participants’ self-rated health status score increased.
In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.
The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission.
A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists’ knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19.
Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5).
Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.
The Middle Jurassic – Early Cretaceous period witnessed the emergence of some major representatives of modern continental vertebrate groups (stem lissamphibians, squamates, therian mammals and birds) and angiosperms, at a time when fragmentation of Pangaea was underway. The successive Moroccan microvertebrate faunas of Ksar Metlili (?Berriasian) and Guelb el Ahmar (Bathonian) from the Anoual Syncline significantly improve our poor knowledge of Gondwanan and especially African palaeobiodiversity at this time. They are among the richest known from the Mesozoic of Gondwana, and are well placed in northwestern Africa to record faunal interchanges with Laurasia. Here we focus on the Ksar Metlili fauna, first documented in the 1980s and most recently resampled in 2010, which produced 24 541 microremains representing 47 species of 8 main groups (Chondrichthyes, Actinopterygii, Sarcopterygii, Lissamphibia, Lepidosauromorpha, Testudinata, Archosauromorpha and Synapsida). It includes remarkable taxa: the oldest stem boreosphenidan mammals from Gondwana, probably some of the last non-mammaliaform cynodonts, a basal ornithischian, possibly freshwater teleosaurid crocodylomorphs, and some of the rare occurrences of choristoderes and albanerpetontids in Gondwana. Comparison of the Ksar Metlili fauna with that of Guimarota (Kimmeridgian, Portugal) further provides evidence of numerous shared taxa of Laurasian affinities, in contrast to the occurrence of few taxa with Gondwanan affinities. This suggests complex palaeobiogeographical relationships – implying both vicariance and dispersal events – of North Africa within Gondwana at the Jurassic–Cretaceous transition. Finally, the faunal similarities with the Guelb el Ahmar fauna question the Cretaceous age of the Ksar Metlili fauna, suggesting an alternative possible Late Jurassic age.
A pycnodont premaxilla bearing a large incisiform tooth with an unusual crown morphology is described from the Palaeocene (Thanetian) phosphate deposits of Morocco. This peculiar tooth shows a broad, fan-shaped multicuspid crown with nine cusps, well adapted for benthic macroalgal scraping. This morph, assigned to a new species of Pycnodus (P. multicuspidatus sp. nov.), emphasizes the phenotypic plasticity of the group and documents an additional trophic specialization among Palaeogene pycnodontiform fishes. In the post-K/Pg boundary marine ecosystem of the Ouled Abdoun Basin, P. multicuspidatus sp. nov. may have opportunistically replaced Maastrichtian fish taxa with a similar front dentition and feeding behaviour, such as the putative specialized pycnodontiforms Stephanodus and Hadrodus.
This paper is aimed at constraining the phylogenetic frame of the acquisition of endothermy by Archosauromorpha. We analyzed the bone histology of Azendohsaurus laaroussii. Stylopodial and zeugopodial bones show three tissue types: (1) avascular lamellar zonal bone formed at low growth rates; (2) a scaffold of parallel-fibered bone containing either small primary osteons or simple vascular canals; and (3) fibrolamellar bone formed at high growth rates. We used quantitative histology to infer the thermometabolic regime of this taxon. We define endothermy as the presence of any mechanism of nonshivering thermogenesis that increases both body temperature and resting metabolic rate. Thus, estimating the resting metabolic rate of an extinct organism may be a good proxy to infer its thermometabolic regime (endothermy vs. ectothermy). High resting metabolic rates have been shown to be primitive for the clade Prolacerta–Archosauriformes. Therefore, we inferred the resting metabolic rates of A. laaroussii, a sister group of this clade, and of 14 extinct related taxa, using phylogenetic eigenvector maps. All the inferences obtained are included in the range of variation of resting metabolic rates measured in mammals and birds, so we can reasonably assume that all these taxa (including Azendohsaurus) were endotherms. A parsimony optimization of the presence of endothermy on a phylogenetic tree of tetrapods shows that this derived character state was acquired by the last common ancestor of the clade Azendohsaurus–Archosauriformes and that there is a reversion in Crocodylia.
The purpose of this study is the verification of intensity modulated radiation therapy (IMRT) head neck treatment planning with one-dimensional and two-dimensional (2D) dosimeters using imaging and radiation oncology core (IROC) Houston head & neck (H&N) phantom.
The image of the H&N phantom was obtained by computed tomography scan which was then transferred to Pinnacle@3 treatment planning system (TPS) for treatment planning. The contouring of the target volumes and critical organ were done manually and dose constraints were set for each organ according to IROC prescription. The plan was optimised by adoptive convolution algorithm to meet the IROC criteria and collapse cone convolution algorithm calculated the delivered doses for treatment. Varian Clinac 2110 was used to deliver the treatment plan to the phantom, the process of irradiation and measurement were repeated three times for reproducibility and reliability. The treatment plan was verified by measuring the doses from thermoluminescent dosimeters (TLDs) and GafChromic external beam therapy 2 films. The agreement between the planned and delivered doses were checked by calculating the percentage dose differences, analysing their isodose line profiles and 2D gamma maps.
The average percent dose difference of 1·8% was obtained between computed doses by TPS and measured doses from TLDs, however these differences were found to be higher for organ at risk. The film dose profile was well in agreement with the planned dose distribution with distance to agreement of 1·5 mm. The gamma analysis of the computed and recorded doses passed the criteria of 3%/3 mm with passing percentages of >96%, which shows successful authentication of delivered doses for IMRT.
IMRT pre-treatment validation can be done with IROC anthropomorphic phantoms, which is essential for the delivery of modulated radiotherapies. It was concluded that films and TLDs can be used as quality assurance tools for IMRT.
This study reported the justification and selection of acceptable γ criteria with respect to low (6 MV) and high (15 MV) photon beams for intensity-modulated radiation therapy quality assurance (IMRT QA) using the Gafchromic external beam therapy 3 (EBT3) film.
Materials and methods
Five-field step-and-shoot IMRT was used to treat 16 brain IMRT patients using the dual-energy DHX-S linear accelerator (Varian Medical System, Palo Alto, CA, USA). Dose comparisons between computed values of the treatment planning system (TPS) and Gafchromic EBT3 film were evaluated based on γ analysis using the Film QA Pro software. The dose distribution was analysed with gamma area histograms (GAHs) generated using different γ criteria (3%/2 mm, 3%/3 mm and 5%/3 mm) for the 6 and 15 MV photon beams, to optimise the best distance-to-agreement (DTA) criteria with respect to the beam energy.
From the comparison between the dose distributions acquired from the TPS and EBT3 film, a DTA criterion of 3%/2 mm showed less dose differences (DDs) with passing rates up to 93% for the 6 MV photon beams, while for the 15 MV a relaxed DTA criterion of 5%/3 mm was consistent with the DD acceptability criteria with a 95% passing rate.
Our results suggested that high-energy photon beams required relaxed DTA criteria for the brain IMRT QA, while low-energy photon beams showed better results even with tight DTA criteria.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
The contamination of the environment, ambulance equipment, and staff hands consequently are major factors which create nosocomial infections in emergency patients. The contamination of equipment and devices plays an important role in nosocomial infections.
The aim of this study was to determine the effectiveness of a disinfectant on the rate of microbial contamination of ambulances in Qom Emergency Medical Services (EMS), Qom, Iran.
This is a quasi-experimental study with a before-after design in order to determine microbial contaminations at the rear and front cabin of ambulances, as well as medical equipment being utilized in Qom EMS. Saya sept-HP-2% solution was used for disinfection. Bacteriological standard methods were used to identify the contaminations.
The contamination rates before and after use of disinfection solution were 52% and eight percent, respectively. Coagulase-negative staphylococci were the most commonly isolated bacterial agent from the equipment (53%). In all equipment, the contamination level has shown a significant reduction after applying disinfectant.
In spite of the fact that the rate of infection from ambulance equipment is high, the results showed that the use of the suitable disinfectant had an effective role in the reduction of bacteria.
FarhadlooR, Goodarzi FarJ, AzadehMR, ShamsS, Parvaresh-MasoudM.Evaluation of Bacterial Contamination on Prehospital Ambulances Before and After Disinfection. Prehosp Disaster Med. 2018;33(6):602–606.
This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.
Materials and Methods
A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.
The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.
Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.
Accurate three-dimensional dosimetry is essential in modern radiotherapy techniques such as volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). In this research work, the PRESAGE® dosimeter was used as quality assurance (QA) tool for VMAT planning for head and neck (H&N) cancer.
Material and method
Computer tomography (CT) scans of an Image Radiation Oncology Core (IROC) H&N anthropomorphic phantom with both IROC standard insert and PRESAGE® insert were acquired separately. Both CT scans were imported into the Pinnacle (9.4 version) TPS for treatment planning, where the structures [planning target volume (PTV), organs at risk) and thermoluminescent detectors (TLDs) were manually contoured and used to optimise a VMAT plan. Treatment planning was done using VMAT (dual arc: 182°–178°, 178°–182°). Beam profile comparisons and gamma analysis were used to quantify agreement with film, PRESAGE® measurement and treatment planning system (TPS) calculated dose distribution.
The average ratio of TLD measured to calculated doses at the four PTV locations in the H&N phantom were between 0·95 to 0·99 for all three VMAT deliveries. Dose profiles were taken along the left–right, the anterior–posterior and superior–inferior axes, and good agreement was found between the PRESAGE® and Pinnacle profile. The mean value of gamma results for three VMAT deliveries in axial and sagittal planes were found to be 94·24 and 93·16% when compared with film and Pinnacle, respectively. The average values comparing the PRESAGE® results and dose values calculated on Pinnacle were observed to be 95·29 and 94·38% in the said planes, respectively, using a 5%/3 mm gamma criteria.
The PRESAGE® dose measurements and calculated dose of pinnacle show reasonable agreement in both axial and sagittal planes for complex dual arc VMAT treatment plans. In general, the PRESAGE® dosimeter is found to be a feasible QA tool of VMAT plan for H&N cancer treatment.
Metabolic syndrome (MetS) refers to a group of risk factors that increase the risk of cardiovascular mortality and morbidity. Dietary habits are among the most important risk factors for MetS. The current study aimed at assessing the effect of dietary habits on the risk of MetS in a 10-year follow-up study in central Iran.
Participants aged 20–74 years without any history of MetS, who were originally recruited for Yazd Healthy Heart Project (YHHP) during 2005–2006, were revisited during 2015–2016. At phase I of YHHP, demographic data, anthropometric measurements, five components of MetS, biochemical tests and dietary habits were evaluated; and the same data were collected in phase II.
A total of 1092 participants were eligible to be included in the present study. After follow-up, the 10-year cumulative incidence of MetS was 56·1 %. After adjustment for potential confounders, increased risk of MetS (hazard ratio; 95 % CI) was found in those who did not try to control their body weight (1·57; 1·06, 2·35), did not usually eat salad (1·91; 1·22, 3·00) and added salt to their food (1·57, 1·06, 2·33). These associations were stronger in men than in the total population after subgroup analysis, but were not present in women.
Dietary habits affect the risk of MetS in the Iranian population. Lifestyle interventions are needed to improve dietary habits to reduce the risk of MetS. Future studies are highly recommended to confirm our results in other populations.
A circularly polarized (CP) and high gain Microstrip antenna is designed in this paper using metamaterial concepts. The antenna, built on a metamaterial substrate, showed significant size reduction and less mutual coupling in an array compared with similar arrays on conventional substrates. Demonstrated to have left-handed magnetic characteristics, the methodology uses complementary split-ring resonators (SRRs) placed horizontally between the patch and the ground plane. In order to reduce mutual coupling in the array structure, hexagonal-SRRs are embedded between antenna elements. The procedure is shown to have great impact on the antenna performance specifically its bandwidth which is broadened from 400 MHz to 1.2 GHz for X-band and as well as its efficiency. The structure has also low loss and improved standing wave ratio and less mutual coupling. The results show that a reduction of 26.6 dB in mutual coupling is obtained between elements at the operation frequency of the array. Experimental data show a reasonably good agreement between simulation and measured results.