A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

Background Computed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose. Results Data were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8). Conclusions Suggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.Peer reviewe

Evolution of scale-free random graphs: Potts model formulation

We study the bond percolation problem in random graphs of $N$ weighted vertices, where each vertex $i$ has a prescribed weight $P_i$ and an edge can connect vertices $i$ and $j$ with rate $P_iP_j$. The problem is solved by the $q\to 1$ limit of the $q$-state Potts model with inhomogeneous interactions for all pairs of spins. We apply this approach to the static model having $P_i\propto i^{-\mu} (0<\mu<1)$ so that the resulting graph is scale-free with the degree exponent $\lambda=1+1/\mu$. The number of loops as well as the giant cluster size and the mean cluster size are obtained in the thermodynamic limit as a function of the edge density, and their associated critical exponents are also obtained. Finite-size scaling behaviors are derived using the largest cluster size in the critical regime, which is calculated from the cluster size distribution, and checked against numerical simulation results. We find that the process of forming the giant cluster is qualitatively different between the cases of $\lambda >3$ and $2 < \lambda <3$. While for the former, the giant cluster forms abruptly at the percolation transition, for the latter, however, the formation of the giant cluster is gradual and the mean cluster size for finite $N$ shows double peaks.Comment: 34 pages, 9 figures, elsart.cls, final version appeared in NP

Complex Probabilities on R^N as Real Probabilities on C^N and an Application to Path Integrals

We establish a necessary and sufficient condition for averages over complex valued weight functions on R^N to be represented as statistical averages over real, non-negative probability weights on C^N. Using this result, we show that many path-integrals for time-ordered expectation values of bosonic degrees of freedom in real-valued time can be expressed as statistical averages over ensembles of paths with complex-valued coordinates, and then speculate on possible consequences of this result for the relation between quantum and classical mechanics.Comment: 4 pages, 0 figure

Structural model of dodecameric heat-shock protein Hsp21:Flexible N-terminal arms interact with client proteins while C-terminal tails maintain the dodecamer and chaperone activity

Small heat-shock proteins (sHsps) prevent aggregation of thermosensitive client proteins in a first line of defense against cellular stress. The mechanisms by which they perform this function have been hard to define due to limited structural information; currently, there is only one high-resolution structure of a plant sHsp published, that of the cytosolic Hsp16.9. We took interest in Hsp21, a chloroplast-localized sHsp crucial for plant stress resistance, which has even longer N-terminal arms than Hsp16.9, with a functionally important and conserved methionine-rich motif. To provide a framework for investigating structure-function relationships of Hsp21 and understanding these sequence variations, we developed a structural model of Hsp21 based on homology modeling, cryo-EM, cross-linking mass spectrometry, NMR, and small-angle X-ray scattering. Our data suggest a dodecameric arrangement of two trimer-of-dimer discs stabilized by the C-terminal tails, possibly through tail-to-tail interactions between the discs, mediated through extended IXVXI motifs. Our model further suggests that six N-terminal arms are located on the outside of the dodecamer, accessible for interaction with client proteins, and distinct from previous undefined or inwardly facing arms. To test the importance of the IXVXI motif, we created the point mutant V181A, which, as expected, disrupts the Hsp21 dodecamer and decreases chaperone activity. Finally, our data emphasize that sHsp chaperone efficiency depends on oligomerization and that client interactions can occur both with and without oligomer dissociation. These results provide a generalizable workflow to explore sHsps, expand our understanding of sHsp structural motifs, and provide a testable Hsp21 structure model to inform future investigations

Class of correlated random networks with hidden variables

We study a class models of correlated random networks in which vertices are characterized by \textit{hidden variables} controlling the establishment of edges between pairs of vertices. We find analytical expressions for the main topological properties of these models as a function of the distribution of hidden variables and the probability of connecting vertices. The expressions obtained are checked by means of numerical simulations in a particular example. The general model is extended to describe a practical algorithm to generate random networks with an \textit{a priori} specified correlation structure. We also present an extension of the class, to map non-equilibrium growing networks to networks with hidden variables that represent the time at which each vertex was introduced in the system

Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes

Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people thatstems from pain demands knowledge improvement through an integration of international knowledge. This study aimed tointegrate current international findings and strengthen the understanding of older people’s experiences of and perspectiveson pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare’s interpretative metaethnographyapproach was conducted. Empirical research papers from journals were collected from various databases. Thesearch process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each inIceland, Norway, the UK, and Australia. The older people’s experiences of pain as well as perspectives on pain managementfrom all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model usingthree themes of ‘‘identity of pain,’’ ‘‘recognition of pain,’’ and ‘‘response to pain.’’ The metaphor of ‘‘normalizing suffering’’was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society’s commonattitude that pain is unavoidable and therefore acceptable in old age in society*among older people themselves as well asthose who are responsible for reporting, acknowledging, and relieving pain*must change. The article emphasizes that painas a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition,healthcare staff require sufficient training to take a person-centered approach towards assessment and management of painthat considers all elements of pain

Fast Scramblers, Horizons and Expander Graphs

We propose that local quantum systems defined on expander graphs provide a simple microscopic model for thermalization on quantum horizons. Such systems are automatically fast scramblers and are motivated from the membrane paradigm by a conformal transformation to the so-called optical metric.Comment: 22 pages, 2 figures. Added further discussion in section 3. Added reference

Living with a double burden: Meanings of pain for women with fibromyalgia

Living with fibromyalgia (FM) means living with a chronic pain condition that greatly influences daily life. The majority of people with FM are middle-aged women. The aim of this study was to elucidate meanings of pain for women with FM. Fifteen women with FM were interviewed about their pain experiences and a phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that meanings of pain for women with FM can be understood as living with a double burden; living with an aggressive, unpredictable pain and being doubted by others in relation to the invisible pain. The ever-present pain was described as unbearable, overwhelming, and dominated the women's whole existence. Nevertheless, all the women tried to normalize life by doing daily chores in an attempt to alleviate the pain. In order to support the women's needs and help them to feel well despite their pain, it is important that nurses and health care personnel acknowledge and understand women with FM and their pain experiences