Analytical Modelling and Simulation of Single and Double Cone Pinholes for Real-Time In-Body Tracking of an HDR Brachytherapy Source

© 2016 IEEE. The choice of pinhole geometry is a critical factor in the performance of pinhole-collimator-based source tracking systems for brachytherapy QA. In this work, an analytical model describing the penetrative sensitivity of a single-cone pinhole collimator to photons emitted from a point source is derived. Using existing models for single-cone resolution and double-cone sensitivity and resolution, the theoretical sensitivity and resolution of the single-cone collimator are quantitatively compared with those of a double-cone collimator with an equivalent field of view. Monte Carlo simulations of the single and double-cone pinhole collimators using an accurate 3D model of a commercial high dose rate brachytherapy source are performed to evaluate the relative performance of each geometry for a novel real-time HDR brachytherapy QA system, HDR BrachyView. The theoretical penetrative sensitivity of the single-cone pinhole is shown to be higher than the double-cone pinhole, which is in agreement with the results from the Monte Carlo simulations. The wider pinhole response function of the single-cone collimator results in a larger total error between the projected center of the source and the estimated center of mass of the source projection for the single-cone collimator, with the greatest error (at the maximum FoV angle) being 0.54 mm for the double-cone pinhole and 1.37 mm for the single-cone at θ = 60°. The double-cone pinhole geometry is determined to be the most appropriate choice for the pinhole collimator in the HDR BrachyView probe

Corticospinal excitability is facilitated by combined action observation and motor imagery of a basketball free throw

Copyright © 2018 The Authors. Objectives: This experiment investigated the extent to which independent action observation, independent motor imagery and combined action observation and motor imagery of a sport-related motor skill elicited activity within the motor system. Design and method: Eighteen, right-handed, male participants engaged in four conditions following a repeated measures design. The experimental conditions involved action observation, motor imagery, or combined action observation and motor imagery of a basketball free throw, whilst the control condition involved observation of a static image of a basketball player holding a basketball. In all conditions, single pulse transcranial magnetic stimulation was delivered to the forearm representation of the left motor cortex. The amplitude of the resulting motor evoked potentials were recorded from the flexor carpi ulnaris and extensor carpi ulnaris muscles of the right forearm and used as a marker of corticospinal excitability. Results: Corticospinal excitability was facilitated significantly by combined action observation and motor imagery of the basketball free throw, in comparison to both the action observation and control conditions. In contrast, the independent use of either action observation or motor imagery did not facilitate corticospinal excitability compared to the control condition. Conclusions: The findings have implications for the design and delivery of action observation and motor imagery interventions in sport. As corticospinal excitability was facilitated by the use of combined action observation and motor imagery, researchers should seek to establish the efficacy of implementing combined action observation and motor imagery interventions for improving motor skill performance and learning in applied sporting settings

Paleolimnological Assessment of Six Lakes on the Kissimmee Chain, with Implications for Restoration of the Kissimmee-Okeechobee-Everglades system, Florida, USA

Whitmore TJ, Riedinger-Whitmore MA, Reed ZE, Curtis JH, Yang H, Evans DE, Cropper NR, Alvarado KS, Lauterman FM, Scott A, Leonard CR, Franklin DL. 2020. Paleolimnological assessment of six lakes on the Kissimmee Chain, with implications for restoration of the Kissimmee–Okeechobee–Everglades system, Florida, USA. Lake Reserv Manage. 36:218–242. The Kissimmee Basin in south central Florida contains a large, freshwater network that includes the Kissimmee River and nearly 2 dozen lakes that are headwaters of the Florida Everglades. Management of these lakes is an important part of Everglades restoration. We report a paleolimnological investigation of 6 lakes in the Upper Kissimmee Basin. Engineering activities connected the lakes and permanently altered hydrology in the 19th and 20th centuries. The lakes were naturally meso-eutrophic, but changes in lake levels and nutrient loading contributed to different degrees of eutrophication. Cyanobacteria were present historically at low levels in Lakes East Tohopekaliga, Cypress, and Tohopekaliga, but increased during the 20th century. Lake Jackson lacked cyanobacteria until recently, but Lakes Kissimmee and Marian have had high levels of cyanobacteria since predisturbance times. Profound changes in the lakes occurred after engineering activities eliminated natural large fluctuations in water levels that periodically dried large portions of the basins. Salt-tolerant biological indicators previously alternated with freshwater organisms. Large water-level fluctuations moderated aquatic-plant standing crops and reduced organic matter accumulation. Lakes Kissimmee and Marian showed greatest evidence of former associated wetlands, but lacked large variations in water levels. We recommend disconnecting these lakes from each other and from the Kissimmee River to reestablish large, natural fluctuations in water levels that were part of healthy ecosystem function. Former wetlands should be restored to slow the downstream cascade of nutrients to Lake Okeechobee and the Everglades. This study demonstrates that paleolimnology is useful for assessing hydrological changes that potentially affect lake restoration efforts

Radiation dose enhancement at tissue-tungsten interfaces in HDR brachytherapy

© 2014 Institute of Physics and Engineering in Medicine. HDR BrachyView is a novel in-body dosimetric imaging system for real-time monitoring and verification of the source position in high dose rate (HDR) prostate brachytherapy treatment. It is based on a high-resolution pixelated detector array with a semi-cylindrical multi-pinhole tungsten collimator and is designed to fit inside a compact rectal probe, and is able to resolve the 3D position of the source with a maximum error of 1.5 mm. This paper presents an evaluation of the additional dose that will be delivered to the patient as a result of backscatter radiation from the collimator. Monte Carlo simulations of planar and cylindrical collimators embedded in a tissue-equivalent phantom were performed using Geant4, with an 192Ir source placed at two different source-collimator distances. The planar configuration was replicated experimentally to validate the simulations, with a MOSkin dosimetry probe used to measure dose at three distances from the collimator. For the cylindrical collimator simulation, backscatter dose enhancement was calculated as a function of axial and azimuthal displacement, and dose distribution maps were generated at three distances from the collimator surface. Although significant backscatter dose enhancement was observed for both geometries immediately adjacent to the collimator, simulations and experiments indicate that backscatter dose is negligible at distances beyond 1 mm from the collimator. Since HDR BrachyView is enclosed within a 1 mm thick tissue-equivalent plastic shell, all backscatter radiation resulting from its use will therefore be absorbed before reaching the rectal wall or other tissues. dosimetry, brachytherapy, HD

Development of a scale to measure stigma related to podoconiosis in Southern Ethiopia

Background: Health-related stigma adds to the physical and economic burdens experienced by people suffering from neglected tropical diseases (NTDs). Previous research into the NTD podoconiosis showed significant stigma towards those with the disease, yet no formal instrument exists by which to assess stigma or interventions to reduce stigma. We aimed to develop, pilot and validate scales to measure the extent of stigma towards podoconiosis among patients and in podoconiosis-endemic communities. Methods: Indicators of stigma were drawn from existing qualitative podoconiosis research and a literature review on measuring leprosy stigma. These were then formulated into items for questioning and evaluated through a Delphi process in which irrelevant items were discounted. The final items formed four scales measuring two distinct forms of stigma (felt stigma and enacted stigma) for those with podoconiosis and those without the disease. The scales were formatted as two questionnaires, one for podoconiosis patients and one for unaffected community members. 150 podoconiosis patients and 500 unaffected community members from Wolaita zone, Southern Ethiopia were selected through multistage random sampling to complete the questionnaires which were interview-administered. The scales were evaluated through reliability assessment, content and construct validity analysis of the items, factor analysis and internal consistency analysis. Results: All scales had Cronbach’s alpha over 0.7, indicating good consistency. The content and construct validity of the scales were satisfactory with modest correlation between items. There was significant correlation between the felt and enacted stigma scales among patients (Spearman’s r = 0.892; p < 0.001) and within the community (Spearman’s r = 0.794; p < 0.001). Conclusion: We report the development and testing of the first standardised measures of podoconiosis stigma. Although further research is needed to validate the scales in other contexts, we anticipate they will be useful in situational analysis and in designing, monitoring and evaluating interventions. The scales will enable an evidencebased approach to mitigating stigma which will enable implementation of more effective disease control and help break the cycle of poverty and NTDs

Appraising and applying evidence about a diagnostic test during a performance-based assessment

BACKGROUND: The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions. METHODS: 4(th )year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an applicable diagnostic test and revised the patient's pretest probability given the test result. RESULTS: The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67). Only one out of 28 (3%) medical students and none of the 15 residents were able to correctly complete the probability revision task (p = 1.00). CONCLUSIONS: This study found that most students completing medical school are able to appraise an article about a diagnostic test but few are able to apply the information from the article to a patient. These findings raise questions about the clinical usefulness of the EBM skills possessed by graduating medical students within the area of diagnostic testing

Hypericum perforatum plant cells reduce Agrobacterium viability during co-cultivation

Plant recalcitrance is the major barrier in developing Agrobacterium-mediated transformation protocols for several important plant species. Despite the substantial knowledge of T-DNA transfer process, very little is known about the factors leading to the plant recalcitrance. Here, we analyzed the basis of Hypericum perforatum L. (HP) recalcitrance to Agrobacterium-mediated transformation using cell suspension culture. When challenged with Agrobacterium, HP cells swiftly produced an intense oxidative burst, a typical reaction of plant defense. Agrobacterium viability started to decline and reached 99% mortality within 12 h, while the plant cells did not suffer apoptotic process. This is the first evidence showing that the reduction of Agrobacterium viability during co-cultivation with recalcitrant plant cells can affect transformation

Text messaging: an innovative method of data collection in medical research

BACKGROUND: The ubiquitous use of mobile phones in sending and receiving text messages has become a norm for young people. Undeniably, text messaging has become a new and important communication medium not only in the social realm but in education as well. The aim of this study is to evaluate the effectiveness of using text messaging as a means to collect data for a medical research project.A cross sectional study was carried out during a double blind, randomized controlled trial to assess the efficacy and safety of a probiotic in the management of Irritable Bowel Syndrome (IBS). The study aim was to assess the response rate of weekly symptom reports via Short Message Service (SMS). The subjects were undergraduates in a private medical university in Malaysia. They were identified through a previous university wide study as suffering from IBS based on Rome III criteria. The subjects were randomly assigned to either the treatment arm receiving a daily probiotic, or the placebo arm. They were required to score their symptoms using eight-item-questionnaires at baseline, and thereafter weekly, for a total of 8 weeks. All subjects were given the choice to communicate their symptom scores by text messaging via mobile phones or by email. SMS text messages were sent to remind trial subjects to attend face-to-face visits and to complete a paper based 34-item-questionnaires on IBS quality of life assessment at baseline and at end of 8 weeks. FINDINGS: The response rate of weekly symptom scores via Short Message Service (SMS) from a total of 38 subjects was 100%. Through the study, 342 reports were submitted: 33.3% of these were received on the due date without reminder, 60.0% one day after the deadline, after a single reminder, 6.1% 2-3 days after the deadline, after 2-3 reminders and 0.6% 5 days after the deadline, after SMS, phone reminder and face-to-face encounter. All SMS symptom reports, whether on time or late, were complete. With the help of SMS reminder, all trial subjects completed the paper based IBS quality of life assessment at baseline and at end of study. CONCLUSIONS: This study found using text messaging via mobile phone an excellent instrument for collecting weekly symptom reports in response to trial medication, reminding trial subjects to attend face to face visits and completing more complex paper based evaluation. The 100% response rate of weekly symptom reports was facilitated by using simple number codes for SMS submission

Evolution favors protein mutational robustness in sufficiently large populations

BACKGROUND: An important question is whether evolution favors properties such as mutational robustness or evolvability that do not directly benefit any individual, but can influence the course of future evolution. Functionally similar proteins can differ substantially in their robustness to mutations and capacity to evolve new functions, but it has remained unclear whether any of these differences might be due to evolutionary selection for these properties. RESULTS: Here we use laboratory experiments to demonstrate that evolution favors protein mutational robustness if the evolving population is sufficiently large. We neutrally evolve cytochrome P450 proteins under identical selection pressures and mutation rates in populations of different sizes, and show that proteins from the larger and thus more polymorphic population tend towards higher mutational robustness. Proteins from the larger population also evolve greater stability, a biophysical property that is known to enhance both mutational robustness and evolvability. The excess mutational robustness and stability is well described by existing mathematical theories, and can be quantitatively related to the way that the proteins occupy their neutral network. CONCLUSIONS: Our work is the first experimental demonstration of the general tendency of evolution to favor mutational robustness and protein stability in highly polymorphic populations. We suggest that this phenomenon may contribute to the mutational robustness and evolvability of viruses and bacteria that exist in large populations