Breast is Best: Determinants of Breastfeeding in Bali

Breastfeeding greatly benefits the health of newborns, providing them with needed antibodies and protection from numerous diseases, including some of the leading causes of infant mortality. This paper explores breastfeeding practices in Bali, and the wide array of factors that have led to these practices. After discussing how breastfeeding fits into the larger context of maternal and newborn health, I explain factors in Bali that affect a woman’s decision to breastfeed and experience while breastfeeding. Determinants include those related to health, financial position, and social status. I explore the history of formula companies and formula as an alternative to breastmilk, as well as current laws in Indonesia related to breastfeeding. I conclude with the areas of greatest potential to improve breastfeeding rates in Bali, as well as the strengths of breastfeeding in Bali that can serve as an example for the rest of the world

Database Plan Quality Impact on Knowledge-based Radiation Therapy Treatment Planning of Prostate Cancer

Purpose: Knowledge-based planning (KBP) leverages plan data from a database of previously treated patients to inform the plan design of a new patient. This work investigated bladder and rectum dose-volume prediction improvements in a common KBP method using a Pareto plan database in VMAT planning for prostate cancer. Methods: We formed an anonymized retrospective patient database of 124 VMAT plans for prostate cancer treated at our institution. From these patient data, two plan databases were compiled. The clinical plan database (CPD) contained planning data from each patient’s clinical plan, which were manually optimized by various planners. The multi-criteria optimization database (MCOD) contained Pareto plan data from plans created using a standardized MCO protocol. Overlap volume histograms, incorporating fractional OAR volumes only within the treatment fields, were computed for each patient and used to match new patient anatomy to similar database patients. For each database patient, CPD and MCOD KBP predictions were generated for D_10, D_30, D_50, D_65, and D_80 of the bladder and rectum in a leave-one-out manner. Prediction achievability was verified through a re-planning study on a subset of 31 randomly selected database patients using the lowest KBP predictions, regardless of plan database origin, as planning goals. Results: MCOD model predictions were significantly lower (p \u3c 0.001) than CPD model predictions for all five bladder dose-volumes and rectum D_50 (p = 0.004) and D_65 (p \u3c 0.001), while CPD model predictions for rectum D_10 (p = 0.005) and D_30 (p \u3c 0.001) were significantly less than MCOD model predictions. KBP model predictions were statistically equivalent to re-planned values for all predicted dose-volumes, excluding D_10 of bladder (p = 0.03) and rectum (p = 0.04). Compared to clinical plans, re-plans showed significant average reductions in D_mean for bladder (7.8 Gy; p \u3c 0.001) and rectum (9.4 Gy; p \u3c 0.001), while maintaining statistically similar PTV, femoral head, and penile bulb dose. Conclusion: KBP dose-volume predictions derived from Pareto plans were lower overall than those resulting from manually optimized clinical plans. A re-planning study showed the KBP dose-volume predictions were achievable and led to significant reductions in bladder and rectum dose

Towards Optimizing Quality Assurance Outcomes of Knowledge-Based Radiation Therapy Treatment Plans Using Machine Learning

Knowledge-based planning (KBP) techniques have been shown to provide improvements in plan quality, consistency, and efficiency for advanced radiation therapies such as volumetric modulated arc therapy (VMAT). While the potential clinical benefits of KBP methods are generally well known, comparatively less is understood regarding the impact of using these systems on resulting plan complexity and pre-treatment quality assurance (QA) measurements, especially for in-house KBP systems. Therefore, the overarching purpose of this work was to assess QA implications with using an in-house KBP system and explore data-driven methods for mitigating increased plan complexity and QA error rates without compromising dosimetric plan quality. Specifically, this study evaluated differences in dose, complexity, and QA outcomes between reference clinical plans and plans designed with a previously established in-house KBP system. Further, a machine learning model – trained and tested using a database of 500 previous VMAT treatment plans and QA measurements – was developed to predict VMAT QA measurements based on selected mechanical features of the plan. This model was deployed as a feedback mechanism within a heuristic optimization algorithm designed to modify plan parameters (identified by the machine learning model as important for accurately predicting QA outcomes) towards improving the predicted delivery accuracy of the plan. While KBP plans achieved average reductions of 6.4 Gy (p \u3c 0.001) and 8.2 Gy (p \u3c 0.001) in mean bladder and rectum dose compared to reference clinical plans across thirty-one prostate patients, significant (p \u3c 0.05) increases in both complexity and QA measurement errors were observed. A support vector machine (SVM) was developed – using a database of 500 previous VMAT plans – to predict gamma passing rates (GPRs; 3%/3mm percent dose-difference/distance-to-agreement with local normalization) based on selected complexity features. A QA-based optimization algorithm was devised by utilizing the SVM model to iteratively modify mechanical treatment features most commonly associated with suboptimal GPRs. The feasibility was evaluated on 13 prostate VMAT plans designed with an in-house KBP method. Using a maximum random leaf gap displacement setting of 3 mm, predicted GPRs increased by an average of 1.14 ± 1.25% (p = 0.006) with minimal differences in dose and radiobiological metrics

The Color of Katrina: A Proposal to Allow Disparate Impact Environmental Claims

Covering this landscape was a brown, filmy sediment left behind by Katrina’s polluted floodwaters, which the U.S. Environmental Protection Agency’s (“EPA”) early tests showed had high levels of E. coli bacteria, oil and gas chemicals, lead, and varying quantities of arsenic. Other tests also found benzo(a)pyrene and petroleum hydrocarbons at levels above the EPA’s safe limit standards.2 Coastal towns became contaminated when the hurricane lifted up bayou sludge, polluted for decades by industrial chemicals, heavy metals, and organic petrochemicals

How Will the Czech Republic Achieve the EU Climate and Energy Targets?

This article argues that the Czech Republic should expand wind power to meet the ever-growing European Union renewable energy requirements and to achieve the Czech Republic’s State Energy Policy objectives. The country could save about $23 billion in initial investment costs by expanding only wind power instead of its current plan of using diversified renewable energy sources

A subject-object asymmetry in the online processing of ’only’: evidence fromeye-tracking

While most formal semantic accounts of focus-sensitive particles such as ‘only’ acknowledge that their interpretationrequires the integration of contextual information with the linguistic representation, it is less clear how this interaction playsout in real-time. Recent psycholinguistic work in this domain favors an incremental processing story, but divergent resultselsewhere complicate this picture. Our findings from two Visual World eye-tracking studies (n = 33, 32) help resolve thisconflict, and confirm the existence of an adult processing asymmetry: sentences in which ‘only’ associates with the subject(’Only John bought an apple’) take longer to process than object-only sentences (’John only bought an apple’). We find thatcurrent accounts of the representation and exhaustification of propositional alternatives invoked by ’only’ do not explain thiseffect. We suggest that differences at the event-structural level — which propositional alternatives arguably map onto — mightexplain the asymmetry