Multidetector CT in children: current concepts and dose reduction strategies

The recent technical development of multidetector CT (MDCT) has contributed to a substantial increase in its diagnostic applications and accuracy in children. A major drawback of MDCT is the use of ionising radiation with the risk of inducing secondary cancer. Therefore, justification and optimisation of paediatric MDCT is of great importance in order to minimise these risks (“as low as reasonably achievable” principle). This review will focus on all technical and non-technical aspects relevant for paediatric MDCT optimisation and includes guidelines for radiation dose level-based CT protocols

Inferring Rn-222 soil fluxes from ambient Rn-222 activity and eddy covariance measurements of CO2

We present a new methodology, which we call Single Pair of Observations Technique with Eddy Covariance (SPOT-EC), to estimate regional-scale surface fluxes of 222Rn from tower-based observations of 222Rn activity concentration, CO2 mole fractions and direct CO2 flux measurements from eddy covariance. For specific events, the regional (222Rn) surface flux is calculated from short-term changes in ambient (222Rn) activity concentration scaled by the ratio of the mean CO2 surface flux for the specific event to the change in its observed mole fraction. The resulting 222Rn surface emissions are integrated in time (between the moment of observation and the last prior background levels) and space (i.e. over the footprint of the observations). The measurement uncertainty obtained is about ±15 % for diurnal events and about ±10 % for longer-term (e.g. seasonal or annual) means. The method does not provide continuous observations, but reliable daily averages can be obtained. We applied our method to in situ observations from two sites in the Netherlands: Cabauw station (CBW) and Lutjewad station (LUT). For LUT, which is an intensive agricultural site, we estimated a mean 222Rn surface flux of (0.29 ± 0.02) atoms cm−2 s−1 with values  > 0.5 atoms cm−2 s−1 to the south and south-east. For CBW we estimated a mean 222Rn surface flux of (0.63 ± 0.04) atoms cm−2 s−1. The highest values were observed to the south-west, where the soil type is mainly river clay. For both stations good agreement was found between our results and those from measurements with soil chambers and two recently published 222Rn soil flux maps for Europe. At both sites, large spatial and temporal variability of 222Rn surface fluxes were observed which would be impractical to measure with a soil chamber. SPOT-EC, therefore, offers an important new tool for estimating regional-scale 222Rn surface fluxes. Practical applications furthermore include calibration of process-based 222Rn soil flux models, validation of atmospheric transport models and performing regional-scale inversions, e.g. of greenhouse gases via the SPOT 222Rn-tracer method

Voice and speech outcomes of chemoradiation for advanced head and neck cancer: a systematic review

Purpose of this review is to systematically assess the effects on voice and speech of advanced head and neck cancer and its treatment by means of chemoradiotherapy (CRT). The databases Medline, Embase and Cochrane were searched (1991–2009) for terms head and neck cancer, chemoradiation, voice and speech rehabilitation. Twenty articles met the inclusion criteria, whereof 14 reported on voice outcomes and 10 on speech. Within the selected 20 studies, 18 different tools were used for speech or voice evaluation. Most studies assessed their data by means of patient questionnaires. Four studies presented outcome measures in more than one dimension. Most studies summarised the outcomes of posttreatment data that were assessed at various points in time after treatment. Except for four studies, pre-treatment measurements were lacking. This and the fact that most studies combined the outcomes of patients with radiated laryngeal cancers with outcome data of non-laryngeal cancer patients impedes an interpretation in terms of the effects of radiation versus the effects of the disease itself on voice or speech. Overall, the studies indicated that voice and speech degenerated during CRT, improved again 1–2 months after treatment and exceeded pre-treatment levels after 1 year or longer. However, voice and speech measures do not show normal values before or after treatment. Given the large-ranged posttreatment data, missing baseline assessment and the lacking separation of tumour/radiation sites, there is an urgent need for structured standardised multi-dimensional speech and voice assessment protocols in patients with advanced head and neck cancer treated with CRT

COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD

BACKGROUND: We developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score. METHODS: In our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed. RESULTS: Eighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach's apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001). CONCLUSIONS: c-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD. TRIAL REGISTRATION NUMBER: NCT01232140

The BAPRAS screening tool for reimbursement in a postbariatric population

Introduction: Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool. Methods: In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes. Results: Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales. Conclusions: Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS

Putting health status guided COPD management to the test:protocol of the MARCH study

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible and usually progressive. Current guidelines, among which the Dutch, have so far based their management strategy mainly on lung function impairment as measured by FEV(1), while it is well known that FEV(1) has a poor correlation with almost all features of COPD that matter to patients. Based on this discrepancy the GOLD 2011 update included symptoms and impact in their treatment algorithm proposal. Health status measures capture both symptoms and impact and could therefore be used as a standardized way to capture the information a doctor could otherwise only collect by careful history taking and recording. We hypothesize that a treatment algorithm that is based on a simple validated 10 item health status questionnaire, the Clinical COPD Questionnaire (CCQ), improves health status (as measured by SGRQ) and classical COPD outcomes like exacerbation frequency, patient satisfaction and health care utilization compared to usual care based on guidelines. METHODS/DESIGN: This hypothesis will be tested in a randomized controlled trial (RCT) following 330 patients for two years. During this period general practitioners will receive treatment advices every four months that are based on the patient’s health status (in half of the patients, intervention group) or on lung function (the remaining half of the patients, usual care group). DISCUSSION: During the design process, the selection of outcomes and the development of the treatment algorithm were challenging. This is discussed in detail in the manuscript to facilitate researchers in designing future studies in this changing field of implementation research. TRIAL REGISTRATION: Netherlands Trial Register, NTR264

Transition Voltage Spectroscopy and the Nature of Vacuum Tunneling

Transition Voltage Spectroscopy (TVS) has been proposed as a tool to analyze charge transport through molecular junctions. We extend TVS to Au-vacuum-Au junctions and study the distance dependence of the transition voltage V_t(d) for clean electrodes in cryogenic vacuum. On the one hand, this allows us to provide an important reference for V_t(d)-measurements on molecular junctions. On the other hand, we show that TVS forms a simple and powerful test for vacuum tunneling models

A Randomized Preventive Rehabilitation Trial in Advanced Head and Neck Cancer Patients Treated with Chemoradiotherapy: Feasibility, Compliance, and Short-term Effects

The aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral cavity, oropharynx, hypopharynx and larynx, or nasopharynx cancer treated with CCRT were randomized into a standard (S) or an experimental (E) preventive rehabilitation arm. Structured multidimensional assessment (i.e., videofluoroscopy, mouth-opening measurement, structured questionnaires) was performed before and 10 weeks after CCRT. In both S and E arms, feasibility was good (all patients could execute the exercises within a week) and compliance was satisfactory (mean days practiced per week was 4). Nevertheless, mouth opening, oral intake, and weight decreased significantly. Compared to similar CCRT studies at our institute, however, fewer patients were still tube-dependent after CCRT. Furthermore, some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises. Patients in the E arm practiced significantly fewer days in total and per week, but they obtained results comparable to the S arm patients. Preventive rehabilitation (regardless of the approach, i.e., experimental or standard) in head and neck cancer patients, despite advanced stage and burdensome treatment, is feasible, and compared with historical controls, it seems helpful in reducing the extent and/or severity of various functional short-term effects of CCRT

Three Years of Δ14CO2 Observations from Maize Leaves in the Netherlands and Western Europe

Atmospheric Δ14CO2 measurements are useful to investigate the regional signals of anthropogenic CO2 emissions, despite the currently scarce observational network for Δ14CO2. Plant samples are an easily attainable alternative, which have been shown to work well as a qualitative measure of the atmospheric Δ14CO2 signals integrated over the time a plant has grown. Here, we present the 14C analysis results for 89 individual maize (Zea mays) plant samples from 51 different locations that were gathered in the Netherlands in the years 2010 to 2012, and from western Germany and France in 2012. We describe our sampling strategy and results, and include a comparison to a model simulation of the Δ14CO2 that would be accumulated in each plant over a growing season. Our model simulates the Δ14CO2 signatures in good agreement with observed plant samples, resulting in a root-mean-square deviation (RMSD) of 3.30‰. This value is comparable to the measurement uncertainty, but still relatively large (20–50%) compared to the total signal. It is also comparable to the spread in Δ14CO2 values found across multiple plants from a single site, and to the spread found when averaging across larger regions. We nevertheless find that both measurements and model capture the large-scale (>100 km) regional Δ14CO2 gradients, with significant observation-model correlations in all three countries in which we collected samples. The modeled plant results suggest that the largest gradients found in the Netherlands and Germany are associated with emissions from energy production and road traffic, while in France, the 14CO2 enrichment from nuclear sources dominates in many samples. Overall, the required model-based interpretation of plant samples adds additional uncertainty to the already relatively large measurement uncertainty in Δ14CO2, and we suggest that future fossil fuel monitoring efforts should prioritize other strategies such as direct atmospheric sampling of CO2 and Δ14CO2

Controlled formation of metallic nanowires via Au nanoparticle ac trapping

Applying ac voltages, we trapped gold nanoparticles between microfabricated electrodes under well-defined conditions. We demonstrate that the nanoparticles can be controllably fused together to form homogeneous gold nanowires with pre-defined diameters and conductance values. Whereas electromigration is known to form a gap when a dc voltage is applied, this ac technique achieves the opposite, thereby completing the toolkit for the fabrication of nanoscale junctions.Comment: Nanotechnology 18, 235202 (2007