SERA: Simulation Environment for Radiotherapy Applications - Users Manual Version 1CO

This document is the user manual for the Simulation Environment for Radiotherapy Applications (SERA) software program developed for boron-neutron capture therapy (BNCT) patient treatment planning by researchers at the Idaho National Engineering and Environmental Laboratory (INEEL) and students and faculty at Montana State University (MSU) Computer Science Department. This manual corresponds to the final release of the program, Version 1C0, developed to run under the RedHat Linux Operating System (version 7.2 or newer) or the Solaris™ Operating System (version 2.6 or newer). SERA is a suite of command line or interactively launched software modules, including graphical, geometric reconstruction, and execution interface modules for developing BNCT treatment plans. The program allows the user to develop geometric models of the patient as derived from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) images, perform dose computation for these geometric models, and display the computed doses on overlays of the original images as three dimensional representations. This manual provides a guide to the practical use of SERA, but is not an exhaustive treatment of each feature of the code

Preventive behaviors and knowledge of tick-borne illnesses: results of a survey from an endemic area

CONTEXT: Lyme disease (LD) is the most commonly reported vector-borne illness in the United States. With physically and economically burdensome effects, it is a concern of public health officials. OBJECTIVES: To assess knowledge and preventive behaviors of individuals in the endemic area of Martha\u27s Vineyard, Massachusetts, to better understand how sociodemographic data and knowledge correlate with preventive behaviors, and to update previous island studies. DESIGN: A 30-item paper-based anonymous survey in either English or Portuguese based on language preference. SETTING: The island of Martha\u27s Vineyard and the ferry between island and mainland. PARTICIPANTS: A total of 946 participants were recruited at 1 of 4 island locations. The majority of participants were traveling by ferry to and from Martha\u27s Vineyard. To reach 2 populations potentially at high risk, that is, youths and outdoor workers, 3 additional venues included the island high school, an English-as-a-Second-Language class, and a local Brazilian church. OUTCOME MEASURES: Four specific preventive behaviors as well as an overall composite prevention score. RESULTS: Participants\u27 knowledge of tick-borne illnesses was poor, and the frequency of practicing preventive behaviors was low; the most commonly reported behavior was checking one\u27s skin for ticks (45%). Approximately one-third of respondents (37%) stated that they did not know the late symptoms of untreated LD, nor did they know early LD treatment options (49%). The 2 high-risk groups reported little participation in preventive measures. In multivariate analyses, only 4 characteristics-older age, confidence in telling deer tick from wood tick, seeing tick-borne illness as a serious threat, and certainty in ability to identify LD symptoms-attained significance associated with preventive behavior as an overall composite score. CONCLUSIONS: Public health interventions focusing on accurately communicating risk, improving knowledge both of LD symptoms and of ticks that carry the disease, as well as teaching preventive behaviors may help reduce tick-borne illness rates

National trends in pancreaticoduodenal trauma: interventions and outcomes

OBJECTIVES: Pancreaticoduodenal trauma (PDT) is associated with substantial mortality and morbidity. In this study, contemporary trends were analysed using national data. METHODS: The Nationwide Inpatient Sample for 1998-2009 was queried for patients with PDT. Interventions including any operation (Any-Op) and pancreas-specific surgery (PSURG) were identified. Trends in treatment and outcomes were determined [complications, length of stay (LoS), mortality] for the Any-Op, PSURG and non-operative (Non-Op) groups. Analyses included chi-squared tests, Cochran-Armitage trend tests and logistic regression. RESULTS: A total of 27 216 patients (nationally weighted) with PDT were identified. Over time, the frequency of PDT increased by 8.3%, whereas the proportion of patients submitted to PSURG declined (from 21.7% to 19.8%; P = 0.0004) and the percentage of patients submitted to non-operative management increased (from 56.7% to 59.1%; P = 0.01). In the Non-Op group, mortality decreased from 9.7% to 8.6% (P \u3c 0.001); morbidity and LoS remained unchanged at approximately 40% and approximately 12 days, respectively. In the PSURG group, mortality remained stable at approximately 15%, complications increased from 50.2% to 71.8% (P \u3c 0.0001) and LoS remained stable at approximately 21 days. For all PDT patients, significant independent predictors of mortality included: the presence of combined pancreatic and duodenal injuries; penetrating trauma, and age over 50 years. Having any operation (Any-Op) was associated with mortality, but PSURG was not a predictor of death. CONCLUSIONS: The utilization of operations for PDT has declined without affecting mortality, but operative morbidity increased significantly over the 12 years to 2009. The development of an evidence-based approach to invasive manoeuvres and an early multidisciplinary approach involving pancreatic surgeons may improve outcomes in patients with these morbid injuries

Socioeconomic and Environmental Proxies for Comparing Freshwater Ecosystem Service Threats across International Sites: A Diagnostic Approach

In this work, we develop and test proxy-based diagnostic tools for comparing freshwater ecosystem services (FWES) risks across an international array of freshwater ecosystems. FWES threats are increasing rapidly under pressure from population, climate change, pollution, land use change, and other factors. We identified spatially explicit FWES threats estimates (referred to as threat benchmarks) and extracted watershed-specific values for an array of aquatic ecosystems in the Western Hemisphere (Ramsar sites). We compared these benchmark values to values extracted for sites associated with an international FWES threat investigation. The resulting benchmark threats appeared to provide a meaningful context for the diagnostic assessment of study site selection by revealing gaps in coverage of the underlying socio-environmental problem. In an effort to simplify the method, we tested regularly updated environmental and socioeconomic metrics as potential proxies for the benchmark threats using regression analysis. Three category proxies, aggregated from (i) external (global to regional, climate-related), (ii) internal (watershed management-related), and (iii) socioeconomic and governance related proxies produced strong relationships with water supply threat benchmarks, but only weak relationships with biodiversity-related and nutrient regulation benchmark threats. Our results demonstrate the utility of advancing global FWES status and threat benchmarks for organizing coordinated research efforts and prioritizing decisions with regard to international socio-environmental problems