A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

"Eighty percent of success is just showing up."—Woody Allen Pediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals that strive for CT quality improvement. We describe our hands-on approach in a pilot project to create a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to (1) assess the acceptability of an interactive educational program and electronic toolkit booklet, (2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and (3) assess the acceptability and practicality of a collaborative approach to implementing dose reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size-specific radiation doses two to three times higher than those at our center. Survey results after a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses

Dynamics of An Underdamped Josephson Junction Ladder

We show analytically that the dynamical equations for an underdamped ladder of coupled small Josephson junctions can be approximately reduced to the discrete sine-Gordon equation. As numerical confirmation, we solve the coupled Josephson equations for such a ladder in a magnetic field. We obtain discrete-sine-Gordon-like IV characteristics, including a flux flow and a ``whirling'' regime at low and high currents, and voltage steps which represent a lock-in between the vortex motion and linear ``phasons'', and which are quantitatively predicted by a simple formula. At sufficiently high anisotropy, the fluxons on the steps propagate ballistically.Comment: 11pages, latex, no figure

Physiotherapy for adults with joint hypermobility syndrome: A pilot randomised controlled trial

Background: Joint Hypermobility Syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment but there is little research investigating its effectiveness. The aim of this study was therefore to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. Methods: A comprehensive physiotherapy intervention was developed in conjunction with patients and healthcare professionals. It was then piloted and refined on the basis of patient and physiotherapist feedback. A parallel two-arm pilot RCT in two UK secondary care NHS Trusts compared 'Advice' against 'Advice & Physiotherapy'. Inclusion criteria were: >16 years, a diagnosis of JHS, and no other musculoskeletal conditions causing pain. The Advice intervention was a one-off session, supplemented by advice booklets from the Hypermobility Syndromes Association and Arthritis Research UK. All patients could ask questions specific to their circumstances and received tailored advice. Participants were then randomly allocated to 'Advice' (no further advice or physiotherapy) or 'Advice & Physiotherapy' (an additional six 30 minute sessions over 4 months). The Physiotherapy intervention was supported by a patient handbook and delivered on a one-to-one patient-therapist basis. It aimed to increase patients’ physical activity through developing knowledge, understanding and skills to better manage their condition. The primary outcome related to the feasibility of conducting a future definitive RCT. Qualitative interviews with patients and physiotherapists therefore formed a major component of data collection. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events); resource use (to estimate cost-effectiveness); and an estimate of the value of information from a future RCT. Outcomes were recorded at baseline, 4 months (at the end of physiotherapy) and 7 months (3 months following physiotherapy). Results: A total of n=29 participants were recruited to the pilot RCT. Recruitment was challenging, primarily due to a perceived lack of equipoise between Advice and Physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the Advice intervention. Some patients reported that the Advice intervention was useful and the Physiotherapy intervention was evaluated very positively. The rate of return of questionnaires was low within the Advice group but reasonable in the Physiotherapy group. The Physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The Advice arm experienced more adverse events. The value of information estimate indicated the potential for high value from a future RCT. Conclusion: A future definitive RCT of physiotherapy for JHS seems feasible, although the Advice intervention should be made more robust to address perceived equipoise and subsequent attrition

Variation of the divertor geometry in Alcator C-Mod

To be published in the Proceedings of the 1 6th IAEA Fusion Energy Conference

Phase I/II Trial of Dose-Escalated Busulfan Delivered by Prolonged Continuous Infusion in Allogeneic Transplant Patients

Intensive chemotherapy or chemotherapy plus irradiation and allogeneic stem cell transplantation can be curative for patients with hematologic diseases. Reduced intensity transplants can also achieve cure, and result in less treatment related mortality but higher relapse rates. Thus, optimizing the conditioning regimens used in allogeneic transplantation remains an important goal. We conducted a Phase I/II trial to determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of a continuous infusion of busulfan over 90 hours in conjunction with fludarabine followed by allogeneic related or unrelated donor transplant. Fifty-four patients with advanced hematologic malignancies were enrolled on this study. The MTD was identified as a 24 hour area under the curve (AUC) of approximately 7095 uMmin which represents a 43% increase over the standard total daily AUC dose of 4800 uMmin given by intermittent schedules. DLTs at doses over 8000 uMmin were identified as a desquamative skin rash and mucositis. No dose-related increase in hepatic, pulmonary or other organ toxicies were seen while efficacy appeared to be improved at higher dose levels. Continuous infusion busulfan with intermittent fludarabine provides an alternative treatment strategy that is generally well tolerated and permits an increase in total busulfan dose with encouraging efficacy

Putting food in the driver’s seat: aligning food-systems policy to advance sustainability, health, and security

Food is a basic need, but seldom a basic policy area. Food systems are widely governed by disconnected policies distributed across a range of sectors including agriculture, education, health, environment, economy, and security. Failure to align food system strategies often results in these disparate policies operating at cross-purposes. Conventional food production and consumption practices contribute to biodiversity decline and climate change, cause diet-related health problems, are associated with worker exploitation, and create national security risks. Drawing on agroecology for cohesive national food strategies can provide benefits across all these sectors: supporting public health, environmental sustainability, economic stability, social cohesion, and national security and sovereignty

Crop Updates 1999 - Lupins

This article contains twenty three papers 1998 LUPIN HIGHLIGHTS LUPIN ANTHRACNOSE 1. Anthracnose overview, Greg Shea, Geoff Thomas and Mark Sweetingham, Agriculture Western Australia 2. Anthracnose – Critical seed infection levels for resistant and susceptible varieties, Geoff Thomas, Mark Sweetingham, Bill O\u27Neill and Greg Shea, Agriculture Western Australia 3. Fungicide seed treatment for anthracnose and brown spot control in lupin, G. Thomas and M. Sweetingham, Agriculture Western Australia LUPIN BREEDING AND AGRONOMY 4. Anthracnose resistance in lupins – an innovative Australian research effort 1996-1998, Wallace Cowling1\u272, Bevan Buirchell1,2 Mark Sweetinqham1,2, Hua\u27an Yang2, Geoff Thomas 1, David Luckett3, Allan Brown4 and John Hamblin2, 1 Agriculture Western Australia, 2 Centre for Legumes in Mediterranean Agriculture, University of Western Australia, 3 NSW Agriculture, Agricultural Institute, Wagga Wagga, NSW, 4 Consultant, 16 Rochester Way, Dianella, WA 5. Gene transfer to pulses: Challenges through 1989-99. Joanne E. Barton, Centre for Legumes in Mediterranean Agriculture, University of Western Australia 6. Can we select for restricted branching in narrow-leafed lupin (Lupinus angustifolius) Kedar Adhikari1, Nick Galwey1and Miles Dracup2, 1Plant Sciences, Faculty of Agriculture, The University of Western Australia,2 Agriculture Western Australia 7. Getting the beat out of new lupin varieties, Dr Bob French, Grain Legume Agronomist, Agriculture Western Australia 8. Starter nitrogen on lupins, Dr Bob French, Grain Legume Agronomist, Agriculture Western Australia APHIDS AND VIRUS CONTROL 9. Forecasting aphid and virus risk in lupins, Debbie Thackray and Roger Jones, CRC for Legumes in Mediterranean Agriculture and Agriculture Western Australia 10. Screening for resistance to cucumber mosaic virus in lupins, Roger Jones, Brenda Coutts, Narelle Reeve, Wallace Cowling and Bevan Buirchell, Agriculture Western Australia and CRC for Legumes in Mediterranean Agriculture 11. The non-necrotic strain of bean yellow mosaic virus spreads faster than the necrotic strain in lupins, Y. Cheng 1 and R.A.C. Jones 1•2, 1 Cooperative Research Centre for Legumes in Mediterranean Agriculture, 2 Agriculture Western Australia 12. Spraying to control aphid feeding damage increases yields of some lupin varieties and faba bean, Francoise Berlandier and Linnet Cartwright, Entomology, Agriculture Western Australia LUPIN NUTRITION 13. Calculated lime requirements for rotations, James Fisher1, Art Diggle 1•2 and Bill Bowden 1•2, 1 Centre for Legumes in Mediterranean Agriculture, 2 Agriculture Western Australia 14. What does lime do to acidic soils – lupin nutrition, Chris Gazey, Research Officer, Agriculture Western Australia 15. Effect of application method of manganese fertiliser and manganese concentration of seed source on seed yield of lupins grown in the West Midlands, Luigi Moreschi, CSBP Area Manager HERBICIDE TOLERANCE AND WEED CONTROL 16. Herbicide tolerance of lupins, Terry Piper, Weed Science Group, Agriculture Western Australia 17. Weed control in Wodjil yellow lupins, Terry Piper, Weed Science Group, Agriculture Western Australia 18. Herbicide tolerance of new lupin varieties, Peter Newman, Agronomist, Elders Mingenew 19. Control of volunteer canola in lupins, Terry Piper and Dave Nicholson, Weed Science Group, Agriculture Western Australia LUPIN ESTABLISHMENT 20. A new seed pressing system for healthy lupin establishment and productivity, Mohammad Amjad, Glen Riethmuller and Ron Jarvis, Agriculture Western Australia 21. Encouragement for controlled traffic farming in the Northern Wheatbelt, Paul Blackwell, Agriculture Western Australia LUPIN HARVESTING 22. Improved lupin harvesting efficiency with different knife guard extensions, Glen Riethmuller, Agriculture Western Australia LUPIN AND PULSE UTILISATION 23. The value of pulse grains for sheep, C.L. White, CSIRO Division of Animal Productio

Crop Updates 2000 - Weeds

This session covers thirty six papers from different authors: INTRODUCTION, Vanessa Stewart Agriculture Western Australia INTEGRATED WEED MANAGEMENT Effect of seeding density, row spacing and Trifluralin on the competitive ability of Annual Ryegrass in a minimum tillage system, David Minkey, Abul Hashem, Glen Riethmuller and Martin Harries, Agriculture Western Australia High wheat seeding rates coupled with narrow row spacing increases yield and suppresses grass, Peter Newman1 and Cameron Weeks2,1Agronomist, Elders Limited 2Mingenew/Irwin Group Resistant ryegrass management in a wheat – lupin rotation, Abul Hashem, Harmohinder S. Dhammu, Aik Cheam, David Bowran and Terry Piper, Agriculture Western Australia Integrated weed management – Will it work with my rotation? Alexandra Wallace, Agriculture Western Australia Long term herbicide resistance trial – Mingenew, Peter Newman Elders, Cameron Weeks Mingenew-Irwin Group Is two years enough? Bill Roy, Agricultural Consulting and Research Services The fate of ryegrass seed when sheep graze chaff cart heaps, Keith L. Devenish1 and Lisa J. Leaver2 1 Agriculture Western Australia, 2Curtin University of Technology, Muresk Institute of Agriculture Can blanket wiping and crop topping prevent seed set of resistant wild radish and mustard? StAbul Hashem, Harmohinder Dhammu, Vanessa Stewart, Brad Rayner and Mike Collins, Agriculture Western Australia The value of green manuring in the integrated management of ryegrass, Marta Monjardino1,2, David Pannell2, Stephen Powles1 ,1Western Australia Herbicide Resistance Initiative, 2Agricultural and Resource Economics, University of Western Australia Some ways of increasing wheat competitiveness against ryegrass,, Mike Collins Centre for Cropping Systems, Agriculture Western Australia WEED BIOLOGY Understanding and driving weed seed banks to very low levels, Sally Peltzer, Agriculture Western Australi HERBICIDE RESISTANCE Cross resistance of chlorsulfuron-resistant wild radish to imidazolinones, Abul Hashem, Harmohinder Dhammu and David Bowran, Agriculture Western Australia Investigation of suspected triazine resistant ryegrass populations for cross-resistance and multiple resistance to herbicides, Michael Walsh, Charles Boyle and Stephen Powles, Western Australian Herbicide Resistance Initiative, University of Western Australia Genetics and fitness of glyphosate resistant ryegrass, S. Powles1, P. Neve1, D. Lorraine-Colwill2, C. Preston2 ,1WAHRI, University of Western Australia 2 CRC Weed Management Systems, University of Adelaide Managing herbicide resistance – the effect of local extinction of resistance genes, Art Diggle1, Paul B. Neve2, Stephen B. Powles2 ,1Agriculture Western Australia, 2WAHRI, Faculty of Agriculture, University of Western Australia The double knock - the best strategy for conserving glyphosate susceptibility? Paul B. Neve1, Art Diggle2, Stephen B. Powles1,1WAHRI, Faculty of Agriculture, University of Western Australia, 2Agriculture Western Australia Wild radish had evolved resistance to triazines, Abul Hashem, Harmohinder S. Dhammu, David Bowran and Aik Cheam, Agriculture Western Australia Ryegrass resistance in Western Australia – where and how much? Rick Llewellyn and Stephen Powles, Western Australian Herbicide Resistance Initiative, Faculty of Agriculture, University of Western Australia Wild radish herbicide resistance survey, Michael Walsh, Ryan Duane and Stephen Powles, Western Australian Herbicide Resistance Initiative, University of Western Australia Knockdown resistance in the Western Australian wheatbelt – a proposed survey, Paul B. Neve1, Abul Hashem2, Stephen B. Powles1,1Western Australian Herbicide Resistance Initiative, University of Western Australia, 2Agriculture Western Australia Diflufenican resistant wild radish, Aik Cheam, Siew Lee, David Bowran, David Nicholson and Abul Hashem, Agriculture Western Australi Multiple resistance to triazines and diflufenican further complicates wild radish control, Aik Cheam, Siew Lee, David Bowran, David Nicholson and Abul Hashem, Agriculture Western Australia HERBICIDE TOLERANCE 25. Herbicide tolerance of lupins, Terry Piper, Weed Science Group, Agriculture Western Australia 26. Tanjil lupins will tolerate metribuzin under the right conditions, Peter Newman, Agronomist Elders Limited and Cameron Weeks, Mingenew/Irwin Group 27. Herbicide damage does not mean lower yield in Lupins, Peter Carlton, Trials Coordinator, Elders Limited 28. Herbicide tolerance of new pea varieties, Dr Terry Piper, Agriculture Western Australia 29. Herbicide tolerance of (waterlogged) wheat, Dr Terry Piper, Agriculture Western Australia 30. Wheat tolerance trials – Mingenew 1999, Peter Newman1, Cameron Weeks2 and Stewart Smith3,1Elders, Mingenew, 2Mingenew-Irwin Group,3Agriculture Western Australia ISSUES OF TRIFLURALIN USE 31. Trifluralin works better on ryegrass when no-tilling into thick wheat stubbles as granules, or mixed with limesand, Bill Crabtree, WANTFA Scientific Officer 32. Increasing trifluralin rate did not compensate for delaying incorporation, Bill Crabtree, WANTFA Scientific Officer 33. Poor emergence survey, 1999, Terry Piper, Weed Science Group, Agriculture Western Australia HERBICIDES – ISSUES AND OPTIONS 34. AFFINITY 400DF – A new herbicide with a new mode of action (Group G) for Broadleaf Weed Control in Cereals, Gordon Cumming, Technical Officer, Crop Care Australasia 35 Herbicide screening for Marshmallow, David Minkey1 and David Cameron2,1Agriculture Western Australia, 2Elders Ltd, Merredin 36. The control of Capeweed in Clearfield Production System for Canola, Mike Jackson and Scott Paton, Cyanamid Agriculture Pty Ltd 37.Effect of herbicides Tordonä 75D and Lontrelä,used for eradication of Skeleton Weed, on production of Lupins I the following seasons, John R. Peirce and Brad J. Rayner, Agriculture Western Australia INDUSTRY PROTECTION 38. Graingaurd – Opportunities for agribusiness to help protect the West Australian grains industry, Greg Shea, Executive Officer, GrainGuard Agriculture Western Australi

Kihi-to, a herbal traditional medicine, improves Abeta(25–35)-induced memory impairment and losses of neurites and synapses

<p>Abstract</p> <p>Background</p> <p>We previously hypothesized that achievement of recovery of brain function after the injury requires the reconstruction of neuronal networks, including neurite regeneration and synapse reformation. Kihi-to is composed of twelve crude drugs, some of which have already been shown to possess neurite extension properties in our previous studies. The effect of Kihi-to on memory deficit has not been examined. Thus, the goal of the present study is to determine the <it>in vivo </it>and <it>in vitro </it>effects of Kihi-to on memory, neurite growth and synapse reconstruction.</p> <p>Methods</p> <p>Effects of Kihi-to, a traditional Japanese-Chinese traditional medicine, on memory deficits and losses of neurites and synapses were examined using Alzheimer's disease model mice. Improvements of Aβ(25–35)-induced neuritic atrophy by Kihi-to and the mechanism were investigated in cultured cortical neurons.</p> <p>Results</p> <p>Administration of Kihi-to for consecutive 3 days resulted in marked improvements of Aβ(25–35)-induced impairments in memory acquisition, memory retention, and object recognition memory in mice. Immunohistochemical comparisons suggested that Kihi-to attenuated neuritic, synaptic and myelin losses in the cerebral cortex, hippocampus and striatum. Kihi-to also attenuated the calpain increase in the cerebral cortex and hippocampus. When Kihi-to was added to cells 4 days after Aβ(25–35) treatment, axonal and dendritic outgrowths in cultured cortical neurons were restored as demonstrated by extended lengths of phosphorylated neurofilament-H (P-NF-H) and microtubule-associated protein (MAP)2-positive neurites. Aβ(25–35)-induced cell death in cortical culture was also markedly inhibited by Kihi-to. Since NF-H, MAP2 and myelin basic protein (MBP) are substrates of calpain, and calpain is known to be involved in Aβ-induced axonal atrophy, expression levels of calpain and calpastatin were measured. Treatment with Kihi-to inhibited the Aβ(25–35)-evoked increase in the calpain level and decrease in the calpastatin level. In addition, Kihi-to inhibited Aβ(25–35)-induced calcium entry.</p> <p>Conclusion</p> <p>In conclusion Kihi-to clearly improved the memory impairment and losses of neurites and synapses.</p