Patient radiation exposure variability and minimization in mobile, C-arm fluoroscopy

BACKGROUND: The frequency of C-arm fluoroscopy procedures is increasing and it has become prudent to increase the awareness of patient radiation exposure to minimize patient risk. There is a strong potential for variability in patient exposure levels and a need for minimizing unnecessary exposure. The variability in C-arm fluoroscopy can be characterized in 2 parts; settings and techniques under the control of the C-arm operator, and the automatic fluoroscope output differences based on equipment type and patient size. METHODS: The two areas of potential variability were studied in the current literature and through exposure measurement research. In order to examine the inherent variability in patient exposure, radiation exposure data were collected from 99 C-arm units, encompassing 21 medical sites, primarily hospitals, with the C-arm units that were in use at these sites. Measurements were conducted to analyze the variation in patient exposure, overall, per site, and per machine manufacturer, using the standard 1.5 inch aluminum attenuation block. Additional measurements were conducted to analyze the variation as a function of patient thickness using multiple 1 inch thick Lucite plates. CONCLUSIONS: Significant patient exposure variability exists in C-arm fluoroscopy and there is potential for unnecessary exposure. Based on literature review and measurement results, the ability to minimize patient exposure relies both on the equipment operator and the inherent design of the C-arm equipment. Measurements demonstrated up to a 261% difference in exposure rates when compared between C-arm manufacturers. Comparison within manufacturers suggests that newer models have improved technology, reducing both exposure rates and associated variability. Exposure rates increased as a function of patient thickness, demonstrating about a 350% increase in dose when patient thickness went from 4 to 8 inches. Recommendations for optimizing operator controlled and equipment design factors are presented.Keywords: patient, radiation, exposure, fluoroscopy, C-arm, variabilit

Distributional congruence of mammalian herbivores in the Trans-Himalayan Mountains

Large-scale distribution and diversity patterns of mammalian herbivores, especially less charismatic species in alpine environments remain little understood. We studied distributional congruence of mammalian herbivores in the Trans-Himalayan region of Ladakh to see if the distributions of less prominent and smaller herbivores can be determined from those of larger and more prominent herbivores like ungulates. Using a similarity index, we assessed shared distributions of species in 20x20 km2 grid-cells in an area of about 80,000 km2. We used the Unweighted Pair-Group Method with Arithmetic Average (UPGMA) to classify mammalian herbivores into groups with similar distributions. We then used the G-test of independence to look for statistical significance of the groups obtained. We identified six groups of mammalian herbivores with distributions more similar than expected at random. The largest group was composed of nine species whereas the other large group comprised six species. Canonical Correspondence Analysis (CCA), used to relate the groups with environmental features, showed that the largest group occurred in higher and flatter areas, while the other large group occurred in lower and steeper areas. Large herbivores like ungulates can be used as surrogate for less prominent small herbivores while identifying areas for latter’s protection in the inaccessible mountainous regions of the Trans-Himalay

Thermoelectric phenomena via an interacting particle system

We present a mesoscopic model for thermoelectric phenomena in terms of an interacting particle system, a lattice electron gas dynamics that is a suitable extension of the standard simple exclusion process. We concentrate on electronic heat and charge transport in different but connected metallic substances. The electrons hop between energy-cells located alongside the spatial extension of the metal wire. When changing energy level, the system exchanges energy with the environment. At equilibrium the distribution satisfies the Fermi-Dirac occupation-law. Installing different temperatures at two connections induces an electromotive force (Seebeck effect) and upon forcing an electric current, an additional heat flow is produced at the junctions (Peltier heat). We derive the linear response behavior relating the Seebeck and Peltier coefficients as an application of Onsager reciprocity. We also indicate the higher order corrections. The entropy production is characterized as the anti-symmetric part under time-reversal of the space-time Lagrangian.Comment: 19 pages, 2 figures, submitted to Journal of Physics

The effect of boldness on decision-making in barnacle geese is group-size-dependent

In group-living species, decisions made by individuals may result in collective behaviours. A central question in understanding collective behaviours is how individual variation in phenotype affects collective behaviours. However, how the personality of individuals affects collective decisions in groups remains poorly understood. Here, we investigated the role of boldness on the decision-making process in different-sized groups of barnacle geese. Naive barnacle geese, differing in boldness score, were introduced in a labyrinth in groups with either one or three informed demonstrators. The demonstrators possessed information about the route through the labyrinth. In pairs, the probability of choosing a route prior to the informed demonstrator increased with increasing boldness score: bolder individuals decided more often for themselves where to go compared with shyer individuals, whereas shyer individuals waited more often for the demonstrators to decide and followed this information. In groups of four individuals, however, there was no effect of boldness on decision-making, suggesting that individual differences were less important with increasing group size. Our experimental results show that personality is important in collective decisions in pairs of barnacle geese, and suggest that bolder individuals have a greater influence over the outcome of decisions in groups

Biomass and diversity of dry alpine plant communities along altitudinal gradients in the Himalayas

A non-linear relationship between phytodiversity and altitude has widely been reported, but the relationship between phytomass and altitude remains little understood.We examined the phytomass and diversity of vascular plants along altitudinal gradients on the dry alpine rangelands of Ladakh, western Himalaya. We used generalized linear and generalized additivemodels to assess the relationship between these vegetation parameters and altitude. We found a humpshaped relationship between aboveground phytomass and altitude.Wesuspect that this is engendered by low rainfall and trampling/excessive grazing at lower slopes by domestic livestock, and low temperature and low nutrient levels at higher slopes.Wealso found a unimodal relationship between plant species-richness and altitude at a singlemountain as well as at the scale of entire Ladakh. The species-richness at the single mountain peaked between 5,000 and 5,200 m, while it peaked between 3,500 and 4,000 m at entire Ladakh level

Math saves the forest

Wireless sensor networks are decentralised networks consisting of sensors that can detect events and transmit data to neighbouring sensors. Ideally, this data is eventually gathered in a central base station. Wireless sensor networks have many possible applications. For example, they can be used to detect gas leaks in houses or fires in a forest.\ud In this report, we study data gathering in wireless sensor networks with the objective of minimising the time to send event data to the base station. We focus on sensors with a limited cache and take into account both node and transmission failures. We present two cache strategies and analyse the performance of these strategies for specific networks. For the case without node failures we give the expected arrival time of event data at the base station for both a line and a 2D grid network. For the case with node failures we study the expected arrival time on two-dimensional networks through simulation, as well as the influence of the broadcast range

Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19

PURPOSE: Our purpose was to investigate the feasibility of pharmacy-initiated pharmacogenetic (PGt) screening in primary care with respect to patient willingness to participate, quality of DNA collection with saliva kits, genotyping, and dispensing data retrieved from the pharmacy. METHODS: Polypharmacy patients aged >60 years who used at least one drug with Anatomical Therapeutic Chemical (ATC) code N06AA01-N06AX19 (antidepressants), A02BC01-A02BC05 (proton-pump inhibitors), N05AA01-N05AH04 (antipsychotics), or C07AB02 (metoprolol) in the preceding 2 years were randomly selected. DNA was collected with saliva kits and genotyped for CYP2D6 and CYP2C19 with the AmpliChip. Pharmacy dispensing records were retrieved and screened for drugs interacting with the patient's CYP2D6 and CYP2C19 genotype by using the evidence-based PGt guidelines from the Dutch Pharmacogenetics Working Group. RESULTS: Out of the 93 invited patients, 54 (58.1%) provided informed consent. Nine saliva samples (16.7%) contained too little DNA. Call rates for CYP2D6 and CYP2C19 were 93.3% and 100%, respectively. Frequencies of genotype-predicted phenotype were 2.4%, 38.1%, 54.8%, and 4.8% for CYP2D6 poor metabolizers (PM), intermediate metabolizers (IM), extensive metabolizers (EM), and ultrarapid metabolizers (UM) respectively. For CYP2C19 genotype-predicted phenotype, frequencies were 2.2%, 15.6%, and 82.2% for PM, IM, and EM, respectively. CONCLUSIONS: This study shows that pharmacy-initiated PGt screening is feasible for a primary care setting

Seasonal diet changes in elephant and impala in mopane woodland

Abstract Elephant and impala as intermediate feeders, having a mixed diet of grass and browse, respond to seasonal fluctuations of forage quality by changing their diet composition. We tested the hypotheses that (1) the decrease in forage quality is accompanied by a change in diet from more monocots in the wet season to more dicots in the dry season and that that change is more pronounced and faster in impala than in elephant; (2) mopane (Colophospermum mopane), the most abundant dicot species, is the most important species in the elephant diet in mopane woodland, whereas impala feed relatively less on mopane due to the high condensed tannin concentration; and (3) impala on nutrient-rich soils have a diet consisting of more grass and change later to diet of more browse than impala on nutrient-poor soils. The phosphorus content and in vitro digestibility of monocots decreased and the NDF content increased significantly towards the end of the wet season, whereas in dicots no significant trend could be detected. We argue that this decreasing monocot quality caused elephant and impala to consume more dicots in the dry season. Elephant changed their diet gradually over a 16-week period from 70% to 25% monocots, whereas impala changed diets rapidly (2-4 weeks) from 95% to 70% monocots. For both elephants and impala, there was a positive correlation between percentage of monocots and dicots in the diet and the in vitro digestibility of these forage items. Mopane was the most important dicot species in the elephant diet and its contribution to the diet increased significantly in the dry season, whereas impala selected other dicot species. On nutrient-rich gabbroic soils, impala ate significantly more monocots than impala from nutrient-poor granitic soils, which was related to the higher in vitro digestibility of the monocots on gabbroic soil. Digestibility of food items appears to be an important determinant of diet change from the wet to the dry season in impala and elephants