Improvement of neutron sensitivity for lithium formate ESR dosimeters: A Monte Carlo analysis

This work presents the computational analysis of the sensitivity improvements that could be achieved in lithium formate monohydrate (LFM) electron paramagnetic resonance (EPR) dosemeters exposed to neutron beams. Monte Carlo (MC) simulations were performed on LFM pellets exposed to neutron beams with different energy spectra at various depths inside a water phantom. Various computations were carried out by considering different enrichments of 6Li inside the LFM matrix as well as addition of different amounts of gadolinium oxide inside the pellet blend. The energy released per unit mass was calculated with the aim of redicting the increase in dose achievable by the addition of sensitizers inside the pellets. As expected, a larger amount of 6Li induces an increase of energy released because of the charged secondary particles (i.e. 3H ions and α particles) produced after neutron capture. For small depths in water phantom and low-energy neutron spectra the dose increase due to 6Li enrichment is high (more than three orders of magnitude with respect to the case of with 7Li). In case of epithermal neutron beams the energy released in 6Li-enriched LFM compound is smaller but larger than in the case of fast neutron beams. On the other hand, the computational analysis evidenced that gadolinium is less effective than 6Li in improving neutron sensitivity of the LFM pellets. Discussion based on the features of MC transport code is provided. This result suggests that 6Li enrichment of LFM dosemeters would be more effective for neutron sensitivity improvement and these EPR dosemeters could be tested for dosimetric applications in Neutron Capture Therapy

A formação acadêmica em terapia ocupacional e as concepções sobre o processo saúde‑doença

Introdução: Diante de uma cultura biológica e organicista, as concepções sobre saúde e doença dialogadas no ensino superior, ainda, são influenciadas pela lógica sintomática e medicalizante. Objetivo: Diante desse contexto, os objetivos deste estudo foram o de analisar tais concepções em uma experiência de ensino‑aprendizagem do curso de terapia ocupacional da Faculdade de Medicina do ABC, em Santo André. Métodos: Como princípio metodológico central, optou‑se pela experiência do aluno, enfocando‑o como sujeito ativo de reflexões/narrativas diante da prática supervisionada. As narrativas foram coletadas por meio de diários de campo individuais e categorizadas em unidades temáticas. Resultados: Percebeu‑se, majoritariamente, que o processo saúde‑doença foi compreendido como polar, um se contrapondo ao outro. Enquanto a saúde foi a expressão de bem‑estar completo/equilíbrio, a doença foi o oposto. Poucos estudantes consideraram a categoria das necessidades sociais em saúde na determinação do processo saúde‑doença na infância. Conclusão: Conclui‑se que essa experiência proporcionou aos alunos a compreensão de que, para o enfrentamento das necessidades em saúde infantil no Capuava, é necessário analisar saúde e doença, primeiramente, como processos vividos, sentidos e contextualizados com a própria história, cultura, subjetividade e inter‑relacionados com os determinantes/necessidades sociais apresentados pelas crianças, sua familia e o entorno

Fundamentos para a prática clínica na terapia ocupacional: a visão de lactentes em foco/ Fundamentals for clinical practice in Occupational Therapy: the view of infants in focus

A atuação do terapeuta ocupacional no campo da saúde ocular e visual para a promoção do desenvolvimento infantil e prevenção de deficiências, requer conhecimento amplo e sólido sobre a complexidade da fundamentação teórica que norteia e sustenta a prática clínica. Ao mesmo tempo, necessita de um olhar individualizado para as potências, comportamentos e características de cada criança, especialmente nos primeiros anos de vida. O presente editorial busca contextualizar conceitos fundamentais sobre processos de plasticidade e maturação neurológica, desenvolvimento ocular e de funções visuais/visuomotoras, relacionar saberes da saúde e educação com níveis de prevenção com base no conhecimento científico. Objetiva minimizar divergências teóricas e conceituais no campo em questão e oferecer suporte teórico para a clínica de terapeutas ocupacionais no processo de intervenção oportuna e habilitação visual de bebês e crianças com diagnóstico ou em risco para alterações no desenvolvimento da visão, a fim de potencializar experiências para a máxima expressão do desenvolvimento infantil.Palavras-chave: Terapia Ocupacional. Saúde Ocular. Prevenção de Doenças. AbstractThe work of the occupational therapist in the field of eye and visual health to promote child development and prevent disabilities requires broad and solid knowledge about the complexity of the theoretical foundation that guides and sustains clinical practice. At the same time, it needs an individualized look at the powers, behaviors and characteristics of each child, especially in the first years of life. This editorial seeks to contextualize fundamental concepts about processes of neurological plasticity and maturation, ocular development and visual/ visomotor functions and to relate health and education knowledge to prevention levels based on scientific knowledge. It aims to minimize theoretical and conceptual divergences in the field in question, and offer theoretical support to the clinic of occupational therapists in the process of timely intervention and visual enabling of babies and children diagnosed or at risk for changes in vision development, in order to enhance experiences for the maximum expression of child development.  Keywords: Occupational Therapy; Eye Health; Disease Prevention.ResumenEl rol del terapeuta ocupacional en el campo de la salud ocular y visual para promover el desarrollo infantil y prevenir discapacidades requiere un conocimiento amplio y sólido sobre la complejidad del fundamento teórico que guía y sustenta la práctica clínica. Al mismo tiempo, necesita una mirada individualizada a los poderes, comportamientos y características de cada niño, especialmente en los primeros años de vida. Este editorial busca contextualizar conceptos fundamentales sobre plasticidad y procesos de maduración neurológica, desarrollo ocular y funciones visuales / visuomotoras y relacionar el conocimiento en salud y educación con niveles de prevención basados en el conocimiento científico. Tiene como objetivo minimizar las divergencias teóricas y conceptuales en el campo en cuestión, y ofrecer apoyo teórico a la clínica de terapeutas ocupacionales en el proceso de intervención oportuna y habilitación visual de bebés y niños diagnosticados o en riesgo de cambios en el desarrollo de la visión, con el fin de potenciar las experiencias para la máxima expresión del desarrollo infantil.Palabras clave: Terapia Ocupacional. Salud Ocular. Prevención de Enfermedades.  

Comparison of appendicular functions released trough sight of pre-term newly born infants and to a term in the first 3 months of life

OBJETIVO: caracterizar e comparar o desenvolvimento de funções apendiculares entre dois grupos de lactentes a termo e pré-termo e verificar se a fixação visual pode ser considerada como um pré-requisito para as ações dos membros superiores. MÉTODO: estudo realizado no Centro de Estudos e Pesquisas em Reabilitação"Prof. Dr. Gabriel Porto", da Universidade Estadual de Campinas em dois grupos: 1) pré-termo, constituído de 21 lactentes, com idade corrigida entre 1 e 3 meses e 2) 21 recém-nascido a termo. Para avaliação utilizou-se o Método de Avaliação da Conduta Visual de Lactentes. Na análise estatística utilizou-se o teste "Q"de Cochran e o teste de Yates. RESULTADOS: verificou-se que, embora, no primeiro mês de vida a fixação visual tenha sido mais frequente no grupo a termo, não se observaram valores de significância estatística para cada grupo e entre eles. Verificou-se diferença estatística mês a mês para o grupo pré-termo e a termo em ambas as funções apendiculares, observando-se o mesmo valor de significância estatística (p = 0,000). Na comparação entre os grupos, tais funções não mostraram diferença significativa, embora tenha sido observado menores frequências nos pré-termo. Apesar da sequência das aquisições apendiculares desencadeadas pela visão ser semelhante nos grupos, o ritmo e o padrão de desenvolvimento apendicular dos lactentes pré-termo, com a idade corrigida, foram diferentes dos a termo, nos aspectos de frequência e qualidade.OBJECTIVE: to characterize and compare the appendicular functions released trough the sight from a pre-term infant group and to a term at the Centro de Estudos e Pesquisas em Reabilitação "Prof. Dr. Gabriel Porto" (Center of Studies and Rehabilitation "Professor Dr. Gabriel Porto", from the State University from Campinas. METHOD: 21 pre-term with gestational age under 37 completed weeks of gestation, suitable weight for the gestational age and corrected age between 1 and 3 months and, 21 to a term with gestational age between 39 to 41 gestational weeks, suitable weight to the gestational age and chronological age between 1 and 3 months. To evaluate it was used the Conduct Visual Infant Method of Evaluation. In the statistic analysis it was used the "Q" test from Cochran and the Test from Yates. RESULTS: although in the first month of life, the visual fixation was more frequent to the terms, it wasn't noticed significant values for each group and between them. In the pre-term and to a term it was noticed a statistic difference in both, the appendicular functions, observing the same value of significant statistic(p=0,000). Between the groups comparison, those functions do not show significant difference, though minor frequency have been observed in the pre-terms. CONCLUSION: the rhythm and the development pattern of appendicular functions released through the sight in the pre-term infants, with corrected age, differ from the term in terms of frequency and quality

Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study

Funder: ZNS - Hannelore Kohl Stiftung; doi: http://dx.doi.org/10.13039/501100007731Funder: Integra LifeSciences CorporationFunder: OneMindAbstract: Background: Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients. Methods: Patients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively. Results: A total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78–1.69), nor with survival at discharge (1.05, 0.58–1.90). Conclusions: Across Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation