1,159 research outputs found
A comparison of gantry-mounted x-ray-based real-time target tracking methods.
PURPOSE: Most modern radiotherapy machines are built with a 2D kV imaging system. Combining this imaging system with a 2D-3D inference method would allow for a ready-made option for real-time 3D tumor tracking. This work investigates and compares the accuracy of four existing 2D-3D inference methods using both motion traces inferred from external surrogates and measured internally from implanted beacons. METHOD: Tumor motion data from 160 fractions (46 thoracic/abdominal patients) of Synchrony traces (inferred traces), and 28 fractions (7 lung patients) of Calypso traces (internal traces) from the LIGHT SABR trial (NCT02514512) were used in this study. The motion traces were used as the ground truth. The ground truth trajectories were used in silico to generate 2D positions projected on the kV detector. These 2D traces were then passed to the 2D-3D inference methods: interdimensional correlation, Gaussian probability density function (PDF), arbitrary-shape PDF, and the Kalman filter. The inferred 3D positions were compared with the ground truth to determine tracking errors. The relationships between tracking error and motion magnitude, interdimensional correlation, and breathing periodicity index (BPI) were also investigated. RESULTS: Larger tracking errors were observed from the Calypso traces, with RMS and 95th percentile 3D errors of 0.84-1.25 mm and 1.72-2.64 mm, compared to 0.45-0.68 mm and 0.74-1.13 mm from the Synchrony traces. The Gaussian PDF method was found to be the most accurate, followed by the Kalman filter, the interdimensional correlation method, and the arbitrary-shape PDF method. Tracking error was found to strongly and positively correlate with motion magnitude for both the Synchrony and Calypso traces and for all four methods. Interdimensional correlation and BPI were found to negatively correlate with tracking error only for the Synchrony traces. The Synchrony traces exhibited higher interdimensional correlation than the Calypso traces especially in the anterior-posterior direction. CONCLUSION: Inferred traces often exhibit higher interdimensional correlation, which are not true representation of thoracic/abdominal motion and may underestimate kV-based tracking errors. The use of internal traces acquired from systems such as Calypso is advised for future kV-based tracking studies. The Gaussian PDF method is the most accurate 2D-3D inference method for tracking thoracic/abdominal targets. Motion magnitude has significant impact on 2D-3D inference error, and should be considered when estimating kV-based tracking error
How weeds emerge: a taxonomic and traitâbased examination using United States data
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106812/1/nph12698.pd
The Extended Learning Curve for Laparoscopic Fundoplication: A Cohort Analysis Of 400 Consecutive Cases
Many studies have looked at the learning curve associated with laparoscopic Nissen fundoplication (LNF) in a given institution. This study looks at the learning curve of a single surgeon with a large cohort of patients over a 10-year period. Prospective data were collected on 400 patients undergoing laparoscopic fundoplication for over 10Â years. The patients were grouped consecutively into cohorts of 50 patients. The operating time, the length of postoperative hospital stay, the conversion rate to open operation, the postoperative dilatation rate, and the reoperation rate were analyzed. Results showed that the mean length of operative time decreased from 143Â min in the first 50 patients to 86Â min in the last 50 patients. The mean postoperative length of hospital stay decreased from 3.7Â days initially to 1.2Â days latterly. There was a 14% conversion to open operation rate in the first cohort compared with a 2% rate in the last cohort. Fourteen percent of patients required reoperation in the first cohort and 6% in the last cohort. Sixteen percent required postoperative dilatation in the first cohort. None of the last 150 patients required dilatation. In conclusion, laparoscopic fundoplication is a safe and effective operation for patients with gastroesophageal reflux disease. New techniques and better instrumentation were introduced in the early era of LNF. The learning curve, however, continues well beyond the first 20 patients
A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015
Abstract Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6Â months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID
Mass and Angular Momentum in General Relativity
We present an introduction to mass and angular momentum in General
Relativity. After briefly reviewing energy-momentum for matter fields, first in
the flat Minkowski case (Special Relativity) and then in curved spacetimes with
or without symmetries, we focus on the discussion of energy-momentum for the
gravitational field. We illustrate the difficulties rooted in the Equivalence
Principle for defining a local energy-momentum density for the gravitational
field. This leads to the understanding of gravitational energy-momentum and
angular momentum as non-local observables that make sense, at best, for
extended domains of spacetime. After introducing Komar quantities associated
with spacetime symmetries, it is shown how total energy-momentum can be
unambiguously defined for isolated systems, providing fundamental tests for the
internal consistency of General Relativity as well as setting the conceptual
basis for the understanding of energy loss by gravitational radiation. Finally,
several attempts to formulate quasi-local notions of mass and angular momentum
associated with extended but finite spacetime domains are presented, together
with some illustrations of the relations between total and quasi-local
quantities in the particular context of black hole spacetimes. This article is
not intended to be a rigorous and exhaustive review of the subject, but rather
an invitation to the topic for non-experts. In this sense we follow essentially
the expositions in Szabados 2004, Gourgoulhon 2007, Poisson 2004 and Wald 84,
and refer the reader interested in further developments to the existing
literature, in particular to the excellent and comprehensive review by Szabados
(2004).Comment: 41 pages. Notes based on the lecture given at the C.N.R.S. "School on
Mass" (June 2008) in Orleans, France. To appear as proceedings in the book
"Mass and Motion in General Relativity", eds. L. Blanchet, A. Spallicci and
B. Whiting. Some comments and references added
Debris Disks: Probing Planet Formation
Debris disks are the dust disks found around ~20% of nearby main sequence
stars in far-IR surveys. They can be considered as descendants of
protoplanetary disks or components of planetary systems, providing valuable
information on circumstellar disk evolution and the outcome of planet
formation. The debris disk population can be explained by the steady
collisional erosion of planetesimal belts; population models constrain where
(10-100au) and in what quantity (>1Mearth) planetesimals (>10km in size)
typically form in protoplanetary disks. Gas is now seen long into the debris
disk phase. Some of this is secondary implying planetesimals have a Solar
System comet-like composition, but some systems may retain primordial gas.
Ongoing planet formation processes are invoked for some debris disks, such as
the continued growth of dwarf planets in an unstirred disk, or the growth of
terrestrial planets through giant impacts. Planets imprint structure on debris
disks in many ways; images of gaps, clumps, warps, eccentricities and other
disk asymmetries, are readily explained by planets at >>5au. Hot dust in the
region planets are commonly found (<5au) is seen for a growing number of stars.
This dust usually originates in an outer belt (e.g., from exocomets), although
an asteroid belt or recent collision is sometimes inferred.Comment: Invited review, accepted for publication in the 'Handbook of
Exoplanets', eds. H.J. Deeg and J.A. Belmonte, Springer (2018
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A systematic review of frameworks for the interrelationships of mental health evidence and policy in low- and middle-income countries
Background: The interrelationships between research evidence and policy-making are complex. Different theoretical frameworks exist to explain general evidenceâpolicy interactions. One largely unexplored element of these interrelationships is how evidence interrelates with, and influences, policy/political agenda-setting. This review aims to identify the elements and processes of theories, frameworks and models on interrelationships of research evidence and health policy-making, with a focus on actionability and agenda-setting in the context of mental health in low- and middle-income countries (LMICs).
Methods: A systematic review of theories was conducted based on the BeHeMOTh search method, using a tested and refined search strategy. Nine electronic databases and other relevant sources were searched for peer-reviewed and grey literature. Two reviewers screened the abstracts, reviewed full-text articles, extracted data and performed quality assessments. Analysis was based on a thematic analysis. The included papers had to present an actionable theoretical framework/model on evidence and policy interrelationships, such as knowledge translation or evidence-based policy, specifically target the agenda-setting process, focus on mental health, be from LMICs and published in English.
Results: From 236 publications included in the full text analysis, no studies fully complied with our inclusion criteria. Widening the focus by leaving out âagenda-settingâ, we included ten studies, four of which had unique conceptual frameworks focusing on mental health and LMICs but not agenda-setting. The four analysed frameworks confirmed research gaps from LMICs and mental health, and a lack of focus on agenda-setting. Frameworks and models from other health and policy areas provide interesting conceptual approaches and lessons with regards to agenda-setting.
Conclusion: Our systematic review identified frameworks on evidence and policy interrelations that differ in their elements and processes. No framework fulfilled all inclusion criteria. Four actionable frameworks are applicable to mental health and LMICs, but none specifically target agenda-setting. We have identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Frameworks from other health/policy areas could offer lessons on agenda-setting and new approaches for creating policy impact for mental health and to tackle the translational gap in LMICs
Dusty Planetary Systems
Extensive photometric stellar surveys show that many main sequence stars show
emission at infrared and longer wavelengths that is in excess of the stellar
photosphere; this emission is thought to arise from circumstellar dust. The
presence of dust disks is confirmed by spatially resolved imaging at infrared
to millimeter wavelengths (tracing the dust thermal emission), and at optical
to near infrared wavelengths (tracing the dust scattered light). Because the
expected lifetime of these dust particles is much shorter than the age of the
stars (>10 Myr), it is inferred that this solid material not primordial, i.e.
the remaining from the placental cloud of gas and dust where the star was born,
but instead is replenished by dust-producing planetesimals. These planetesimals
are analogous to the asteroids, comets and Kuiper Belt objects (KBOs) in our
Solar system that produce the interplanetary dust that gives rise to the
zodiacal light (tracing the inner component of the Solar system debris disk).
The presence of these "debris disks" around stars with a wide range of masses,
luminosities, and metallicities, with and without binary companions, is
evidence that planetesimal formation is a robust process that can take place
under a wide range of conditions. This chapter is divided in two parts. Part I
discusses how the study of the Solar system debris disk and the study of debris
disks around other stars can help us learn about the formation, evolution and
diversity of planetary systems by shedding light on the frequency and timing of
planetesimal formation, the location and physical properties of the
planetesimals, the presence of long-period planets, and the dynamical and
collisional evolution of the system. Part II reviews the physical processes
that affect dust particles in the gas-free environment of a debris disk and
their effect on the dust particle size and spatial distribution.Comment: 68 pages, 25 figures. To be published in "Solar and Planetary
Systems" (P. Kalas and L. French, Eds.), Volume 3 of the series "Planets,
Stars and Stellar Systems" (T.D. Oswalt, Editor-in-chief), Springer 201
Circumstellar discs: What will be next?
This prospective chapter gives our view on the evolution of the study of
circumstellar discs within the next 20 years from both observational and
theoretical sides. We first present the expected improvements in our knowledge
of protoplanetary discs as for their masses, sizes, chemistry, the presence of
planets as well as the evolutionary processes shaping these discs. We then
explore the older debris disc stage and explain what will be learnt concerning
their birth, the intrinsic links between these discs and planets, the hot dust
and the gas detected around main sequence stars as well as discs around white
dwarfs.Comment: invited review; comments welcome (32 pages
Surveillance of Airborne Adenovirus and Mycoplasma pneumoniae in a Hospital Pediatric Department
This investigation evaluated the distributions of airborne adenovirus and Mycoplasma pneumoniae in public areas in the pediatric department of Children's Hospital in northern Taiwan. The airborne viral and bacterial concentrations were evaluated twice a week for a year using filter sampling with an airflow rate of 12 liters per minute for eight hours in the pediatric outpatient department and 24 hours in the pediatric emergency room. Real-time polymerase chain reaction assays were conducted for analysis. Approximately 18% of the air samples from the pediatric emergency room were found to contain adenovirus. Approximately forty-six percent of the air samples from the pediatric outpatient department contained Mycoplasma pneumoniae DNA products. High detection rates of airborne adenovirus DNA were obtained in July and August in the pediatric public areas. Airborne Mycoplasma pneumoniae was detected only in July in the pediatric emergency room and the peak levels were found from August to January in the pediatric outpatient department. Airborne particles that contained adenovirus and Mycoplasma pneumoniae were the most prevalent in the pediatric public areas. The potential relationship between these airborne viral/bacterial particles and human infection should be examined further
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