When is Better Best? A multiobjective perspective

Purpose: To identify the most informative methods for reporting results of treatment planning comparisons. Methods: Seven papers from the past year of International Journal of Radiation Oncology Biology Physics reported on comparisons of treatment plans for IMRT and IMAT. The papers were reviewed to identify methods of comparisons. Decision theoretical concepts were used to evaluate the study methods and highlight those that provide the most information. Results: None of the studies examined the correlation between objectives. Statistical comparisons provided some information but not enough to make provide support for a robust decision analysis. Conclusion: The increased use of treatment planning studies to evaluate different methods in radiation therapy requires improved standards for designing the studies and reporting the results

Lobowings: A Pilot Study of Interprofessional Patient Safety Training

UNMHSC has endorsed Interprofessional Education (IPE) and is committed to developing meaningful curriculum and IPE experiences that will allow students to learn with and from each other about interprofessional collaborative practices. LoboWings training (developed by UNM Hospital) is designed to promote a culture of patient safety and teamwork through application of Crew Resource Management (CRM) techniques similar to those used in airline safety programs.https://digitalrepository.unm.edu/hsc_ipe_posters/1000/thumbnail.jp

Complementary and Alternative Medicine (CAM) Use in Pediatric Oncology: A new horizon or costly myth?

Complementary and alternative medicines (CAMs) are increasingly being utilized in the pediatric cancer population, despite unproven risks and benefits, and significant additional cost of treatment. Objective: To identify the prevalence of CAM use and the most frequently utilized CAMs, and to examine the physiologic impact of CAM in pediatric cancer patients undergoing chemotherapy. Additional objectives included identifying the cost associated with CAM, and the rationale for CAM usage

Topological Sector Fluctuations and Curie Law Crossover in Spin Ice

At low temperatures, a spin ice enters a Coulomb phase - a state with algebraic correlations and topologically constrained spin configurations. In Ho2Ti2O7, we have observed experimentally that this process is accompanied by a non-standard temperature evolution of the wave vector dependent magnetic susceptibility, as measured by neutron scattering. Analytical and numerical approaches reveal signatures of a crossover between two Curie laws, one characterizing the high temperature paramagnetic regime, and the other the low temperature topologically constrained regime, which we call the spin liquid Curie law. The theory is shown to be in excellent agreement with neutron scattering experiments. On a more general footing, i) the existence of two Curie laws appears to be a general property of the emergent gauge field for a classical spin liquid, and ii) sheds light on the experimental difficulty of measuring a precise Curie-Weiss temperature in frustrated materials; iii) the mapping between gauge and spin degrees of freedom means that the susceptibility at finite wave vector can be used as a local probe of fluctuations among topological sectors.Comment: 10 pages, 5 figure

An in vivo investigation of the initiation and progression of subchondral cysts in a rodent model of secondary osteoarthritis

Introduction: Subchondral bone cysts (SBC) have been identified in patients with knee osteoarthritis (OA) as a cause of greater pain, loss of cartilage and increased chance of joint replacement surgery. Few studies monitor SBC longitudinally, and clinical research using three-dimensional imaging techniques, such as magnetic resonance imaging (MRI), is limited to retrospective analyses as SBC are identified within an OA patient cohort. The purpose of this study was to use dual-modality, preclinical imaging to monitor the initiation and progression of SBC occurring within an established rodent model of knee OA.Methods: Eight rodents underwent anterior cruciate ligament transection and partial medial meniscectomy (ACLX) of the right knee. In vivo 9.4 T MRI and micro-computed tomography (micro-CT) scans were performed consecutively prior to ACLX and 4, 8, and 12 weeks post-ACLX. Resultant images were co-registered using anatomical landmarks, which allowed for precise tracking of SBC size and composition throughout the study. The diameter of the SBC was measured, and the volumetric bone mineral density (vBMD) was calculated within the bone adjacent to SBC. At 12 weeks, the ACLX and contralateral knees were processed for histological analysis, immunohistochemistry, and Osteoarthritis Research Society International (OARSI) pathological scoring.Results: At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. Imaging data revealed that the SBC originate in the presence of a subchondral bone plate breach, with evolving composition over time. The diameter of the SBC increased significantly over time (P = 0.0033) and the vBMD significantly decreased at 8 weeks post-ACLX (P = 0.033). Histological analysis demonstrated positive staining for bone resorption and formation surrounding the SBC, which were consistently located beneath the joint surface with the greatest cartilage damage. Trabecular bone adjacent the SBC lacked viable osteocytes and, combined with bone marrow changes, indicated osteonecrosis.Conclusions: This study provides insight into the mechanisms leading to SBC formation in knee OA. The expansion of these lesions is due to stress-induced bone resorption from the incurred mechanical instability. Therefore, we suggest these lesions can be more accurately described as a form of OA-induced osteonecrosis, rather than \u27subchondral cysts\u27. © 2012 McErlain et al.; licensee BioMed Central Ltd

An in vivo investigation of the initiation and progression of subchondral cysts in a rodent model of secondary osteoarthritis

Introduction: Subchondral bone cysts (SBC) have been identified in patients with knee osteoarthritis (OA) as a cause of greater pain, loss of cartilage and increased chance of joint replacement surgery. Few studies monitor SBC longitudinally, and clinical research using three-dimensional imaging techniques, such as magnetic resonance imaging (MRI), is limited to retrospective analyses as SBC are identified within an OA patient cohort. The purpose of this study was to use dual-modality, preclinical imaging to monitor the initiation and progression of SBC occurring within an established rodent model of knee OA.Methods: Eight rodents underwent anterior cruciate ligament transection and partial medial meniscectomy (ACLX) of the right knee. In vivo 9.4 T MRI and micro-computed tomography (micro-CT) scans were performed consecutively prior to ACLX and 4, 8, and 12 weeks post-ACLX. Resultant images were co-registered using anatomical landmarks, which allowed for precise tracking of SBC size and composition throughout the study. The diameter of the SBC was measured, and the volumetric bone mineral density (vBMD) was calculated within the bone adjacent to SBC. At 12 weeks, the ACLX and contralateral knees were processed for histological analysis, immunohistochemistry, and Osteoarthritis Research Society International (OARSI) pathological scoring.Results: At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. Imaging data revealed that the SBC originate in the presence of a subchondral bone plate breach, with evolving composition over time. The diameter of the SBC increased significantly over time (P = 0.0033) and the vBMD significantly decreased at 8 weeks post-ACLX (P = 0.033). Histological analysis demonstrated positive staining for bone resorption and formation surrounding the SBC, which were consistently located beneath the joint surface with the greatest cartilage damage. Trabecular bone adjacent the SBC lacked viable osteocytes and, combined with bone marrow changes, indicated osteonecrosis.Conclusions: This study provides insight into the mechanisms leading to SBC formation in knee OA. The expansion of these lesions is due to stress-induced bone resorption from the incurred mechanical instability. Therefore, we suggest these lesions can be more accurately described as a form of OA-induced osteonecrosis, rather than \u27subchondral cysts\u27. © 2012 McErlain et al.; licensee BioMed Central Ltd

A Hierachical Evolutionary Algorithm for Multiobjective Optimization in IMRT

Purpose: Current inverse planning methods for IMRT are limited because they are not designed to explore the trade-offs between the competing objectives between the tumor and normal tissues. Our goal was to develop an efficient multiobjective optimization algorithm that was flexible enough to handle any form of objective function and that resulted in a set of Pareto optimal plans. Methods: We developed a hierarchical evolutionary multiobjective algorithm designed to quickly generate a diverse Pareto optimal set of IMRT plans that meet all clinical constraints and reflect the trade-offs in the plans. The top level of the hierarchical algorithm is a multiobjective evolutionary algorithm (MOEA). The genes of the individuals generated in the MOEA are the parameters that define the penalty function minimized during an accelerated deterministic IMRT optimization that represents the bottom level of the hierarchy. The MOEA incorporates clinical criteria to restrict the search space through protocol objectives and then uses Pareto optimality among the fitness objectives to select individuals. Results: Acceleration techniques implemented on both levels of the hierarchical algorithm resulted in short, practical runtimes for optimizations. The MOEA improvements were evaluated for example prostate cases with one target and two OARs. The modified MOEA dominated 11.3% of plans using a standard genetic algorithm package. By implementing domination advantage and protocol objectives, small diverse populations of clinically acceptable plans that were only dominated 0.2% by the Pareto front could be generated in a fraction of an hour. Conclusions: Our MOEA produces a diverse Pareto optimal set of plans that meet all dosimetric protocol criteria in a feasible amount of time. It optimizes not only beamlet intensities but also objective function parameters on a patient-specific basis

Deprivation, clubs and drugs: results of a UK regional population-based cross-sectional study of weight management strategies

Background Despite rising levels of obesity in England, little is known about slimming club and weight loss drug (medication) use or users. In order to inform future commissioning, we report the prevalence of various weight management strategies and examine the associations between slimming club and medication use and age, gender, deprivation and body mass index. Methods A population based cross-sectional survey of 26,113 adults was conducted in South Yorkshire using a self-completed health questionnaire. Participants were asked whether they had ever used the following interventions to manage their weight: increasing exercise, healthy eating, controlling portion size, slimming club, over the counter weight loss medication, or meal replacements. Factors associated with slimming club and weight-loss medication use were explored using logistic regression. Results Over half of the sample was either overweight (36.6%) or obese (19.6%). Obesity was more common in the most deprived areas compared to the least deprived (26.3% vs. 12.0%). Healthy eating (49.0%), controlling portion size (43.4%), and increasing exercise (43.0%) were the most commonly reported weight management strategies. Less common strategies were attending a slimming club (17.2%), meal replacements (3.4%) and weight-loss medication (3.2%). Adjusting for BMI, age, deprivation and long standing health conditions, women were significantly more likely to report ever using a slimming club (adjusted OR = 18.63, 95% CI = 16.52–21.00) and more likely to report ever using over the counter weight-loss medications (AOR = 3.73, 95% CI = 3.10-4.48), while respondents from the most deprived areas were less likely to report using slimming clubs (AOR = 0.60, 95% CI = 0.53-0.68), and more likely to reporting using weight loss medications (AOR =1.38, 95% CI = 1.05-1.82). Conclusion A large proportion of individuals report having used weight management strategies. Slimming clubs and over-the-counter weight loss medication account for a smaller proportion of the overall uptake. Those from less deprived areas were more likely to use slimming clubs while those from more deprived areas were more likely to use weight-loss medications. Future NHS and Local Authority commissioning of weight management services must be aware of this varying social gradient in weight management strategies

Adapting relationships with place: Investigating the evolving place attachment and ‘sense of place’ of UK higher education students during a period of intense transition

In recent years interest has emerged regarding the geographies of higher education students, particularly in patterns of mobility and dispersion. While anecdotal rhetoric suggests a ‘typical student’ exists within UK institutions. What resonates is the notion that students are inherently heterogeneous, experiencing University in differing ways and times according to their circumstances and year of study. This paper uses ‘walking interviews’ conducted with University of Portsmouth students as a method to unpack how ‘non-local’ students might go about interpreting their sense of place within their term-time location. This methodology was designed specifically to ensure discussions of ‘sense of place’ remain directly in the context of the city and recognises the adaptive relationships students have with their term-time locations. This is important as there is a tendency within the literature to focus solely on the transition into University, ignoring that students often experience pressures throughout their degree pathway. These pressures can be linked to various social and spatial changes, such as insecurities regarding fitting in amongst unfamiliar peer groups or a lack of confidence concerning engagement with academic and non-academic practices, and draws attention to the non-linearity of students’ associations with their term-time location