Education and training of medical physicists in South East Asia: accomplishments and challenges†

John Cameron has made significant contributions to the field of Medical Physics. His contributions encompassed research and development, technical developments and education. He had a particular interest in the education of medical physicists in developing countries. Structured clinical training is also an essential component of the professional development of a medical physicist. This paper considers aspects of the clinical training and education of medical physicists in South-East Asia and the challenges facing the profession in the region if it is to keep pace with the rapid increase in the amount and technical complexity of medical physics infrastructure in the region

Tailored treatment options for patients with psoriatic arthritis and psoriasis: review of established and new biologic and small molecule therapies

The diverse clinical picture of PsA suggests the need to identify suitable therapies to address the different combinations of clinical manifestations. This review aimed to classify the available biologic agents and new small molecule inhibitors (licensed and nonlicensed) based on their proven efficacy in treating different clinical manifestations associated with psoriasis and PsA. This review presents the level of evidence of efficacy of different biologic treatments and small molecule inhibitors for certain clinical features of treatment of PsA and psoriasis, which was graded in categories I–IV. The literature searches were performed on the following classes of biologic agents and small molecules: TNF inhibitors (adalimumab, etanercept, infliximab, golimumab, certolizumab), anti-IL12/IL23 (ustekinumab), anti-IL17 (secukinumab, brodalumab, ixekizumab), anti-IL6 (tocilizumab), T cell modulators (alefacept, efalizumab, abatacept, itolizumab), B cell depletion therapy (rituximab), phosphodiesterase 4 inhibitor (apremilast) and Janus kinase inhibitor (tofacitinib). A comprehensive table including 17 different biologic agents and small molecule inhibitors previously tested in psoriasis and PsA was generated, including the level of evidence of their efficacy for each of the clinical features included in our review (axial and peripheral arthritis, enthesitis, dactylitis, and nail and skin disease). We also proposed a limited set of recommendations for a sequential biologic treatment algorithm for patients with PsA who failed the first anti-TNF therapy, based on the available literature data. There is good evidence that many of the biologic treatments initially tested in psoriasis are also effective in PsA. Further research into both prognostic biomarkers and patient stratification is required to allow clinicians the possibility to make better use of the various biologic treatment options available. This review showed that there are many potentially new treatments that are not included in the current guidelines that can be used for selected categories of patients based on their disease phenotype, clinician experience and access to new biologic therapies

Established and new biologic therapies for psoriatic arthritis and psoriasis

Psoriatic arthritis (PsA) is part of the group of seronegative spondyloarthropathies (SpA). These diseases share common clinical features such as sacroiliitis, spondylitis, enthesitis, psoriasis, uveitis, and genetic markers. The newly developed biologic treatments aim to target molecular and cellular abnormalities associated with autoimmunity in PsA and psoriasis. There are several biologic agents which are currently used, or are under investigation in both diseases, which creates an opportunity for rheumatologists and dermatologists to share their expertise for patients’ benefit. Apart from the large body of evidence for efficacy of the licensed biologic therapies in psoriasis and PsA, research efforts are currently put into discovering and testing new molecular targets with therapeutic potential. This chapter will review all the biologic agents ever tested in these two diseases, stratified based on the level of evidence regarding their efficacy. As PsA and psoriasis have a diverse clinical phenotype, it is useful to identify which treatments are effective for a particular clinical manifestation, such as axial and peripheral arthritis, dactylitis, enthesitis, skin and nail disease. Another aspect of biologic treatment effectiveness that will be explored in this chapter is the impact of these agents on patients’ quality of life and functional ability. We propose that by analysing the patient’s individual disease phenotype, based on clinical assessments and biomarkers, there is a huge opportunity to optimise the cost-effectiveness of biologic treatments, by facilitating tailored treatment options for patients with PsA and psoriasis

Reflection of Ultrasonic Waves by an Imperfect Diffusion Bond

The analytical treatment of the reflection of ultrasonic wave motion by a planar distribution of cracks is of interest for the nondestructive evaluation of imperfect diffusion bonds. Preliminary results for an experimental approach have been given by Hosten et al.1, for two bonded stainless steel cylinders. In practice, new high strength steel tubing has complicated the pinch welding process and placed emphasis on the integrity of the resulting weld, see Rehbein et al2, Thomas et al3. Two ultrasonic nondestructive evaluation techniques to find defects in the pinch weld and to determine weld strength have been discussed by Thomas et al.4

“You Should Just Keep Your Mouth Shut and Do As We Say”: Forensic Psychiatric Inpatients’ Experiences of Risk Assessments

This study presents findings of forensic inpatients’ experiences of their role in the risk assessment process. Eleven patients, recruited from two forensic psychiatric clinics in Sweden, participated in semi-structured interviews which were analyzed using qualitative content analysis. The analysis of their experiences resulted in the information of three categories: Taking responsibility for one’s own situation, in terms of taking responsibility for aspects of one’s care, taking charge of the present, emphasizing potential challenges in grasping reality, and being involved and having impact, which concerns feelings of being involved in discussions related to one’s care and treatment versus feelings of being an outsider

Alkali-rich replacement zones in evolved NYF pegmatites: metasomatic fluids or immiscible melts?

IMA2018 Abstract submission Pegmatite mineralogy, geochemistry, classification and origins IMA2018-1337 Alkali-rich replacement zones in evolved NYF pegmatites: metasomatic fluids or immiscible melts? Axel Muller* 1, John Spratt2, Rainer Thomas3, Ben J. Williamson4, Reimar Seltmann2 1Natural History Museum, University of Oslo, Oslo, Norway, 2Department of Earth Sciences, Natural History Museum, London, United Kingdom, 3Chemistry and Physics of Earth Materials, German Research Centre for Geoscience GFZ, Potsdam, Germany, 4Camborne School of Mines, University of Exeter, Penryn, United Kingdom What is your preferred presentation method?: Oral or poster presentation : Replacement zones (RZ), which are a common feature of evolved granitic pegmatites, are irregular, commonly alkali-rich zones superimposing, cross-cutting and replacing the primary zonation in almost all consolidated pegmatite bodies. RZ are widely considered to result from late-stage metasomatism even though little is known about the melts and/or fluids involved in their formation. However, the observed textures and mineral paragenesis of RZ cannot be explained by metasomatism in a strict sense. In this study, the nature of the late stage silicate melt forming “cleavelandite” RZ is assessed from textural, mineralogical, chemical and melt inclusion studies of evolved, Proterozoic Niobium-Yttrium-Fluorine (NYF) rare metal pegmatites from Evje–Iveland, southern Norway. These were studied as they are mineralogically simple, compared with RZ in evolved Lithium-Caesium-Tantalum (LCT) pegmatites. Silicate melt inclusions in RZ-forming topaz and “cleavelandite” document high H2O contents of up to18 wt.% of the F-rich silicate melt from which the RZ crystallized. In addition, from mineral compositions (“cleavelandite”, “amazonite”, white mica, garnet, columbite group minerals, topaz, fluorite, and beryl), they must have also been strongly alkaline (Na-dominated) with enrichments in F (at least 4 wt.%), Cs, Rb, Ta, Nb, Mn, Ge, Bi, As, and in some cases also Li compared with host pegmatites. These elements are concentrated in a few RZ-forming minerals resulting in very distinctive mineral-trace element signatures. “Amazonite” is strongly enriched in Cs and Rb and often white mica and beryl in Li and Cs. To acquire these mineral compositions, the overall Li-Cs-Ta-poor Evje-Iveland original pegmatite melt must have undergone extreme internal chemical differentiation resulting in melt/melt immiscibility aiding rheology contrasts and resulting in RZ formation. The resulting RZ-forming H2O-F-rich silicate melt would have shown large differences in viscosity and density, and therefore physical flow/transport properties, to the host pegmatite melt resulting in discordant contacts. The mineralogy and melt inclusion data from the Evje-Iveland pegmatites document a gradient of crystallization temperatures within the investigated pegmatite bodies with highest temperatures at the pegmatite margin (during initial emplacement, ~680°C) and lowest temperatures within the RZ (<500°C). Considering the temperature and pressure conditions of the host rocks gneisses and amphibolites (~650°C, up to 5 kbar) at the time of pegmatite emplacement and the crystallization conditions of the RZ, the Evje- Iveland pegmatites and RZ likely formed over a period of 2.2 million years, assuming an exhumation rate of 1.5 mm per million years and a geothermal gradient of 45°C km-1. Such a long crystallization time contradicts the classical view that pegmatites represent strongly undercooled melts which crystallize relatively fast.The attached document is the authors’ submitted version of the oral presentation. You are advised to consult the publisher’s version if you wish to cite from it

Experimental determination of concentration factors of Mn, Zn and I in the phytoplankton species Phaeodactylum Tricornutum

Anthropogenic radionuclides released into the environment cause a radiation dose to wildlife and humans which must be quantified, both to assess the effect of normal releases, and to predict the consequences of a larger, unplanned release. To estimate the spread of the radioactive elements, the ecosystem around release points is modelled, and element uptake is usually quantified by concentration factors (CF), which relates the concentration of an element in an organism to the concentration of the same element in a medium under equilibrium conditions. In this work, we experimentally determine some phytoplankton CF that are needed for improved modelling of the marine ecosystems around nuclear facilities and release points. CFs that require better determination have been identified through literature search. Sensitivity studies, using the currently used ecosystem modelling software PREDO, show that for most studied groups, the dose committed by the respective radionuclides is almost proportional to the corresponding phytoplankton CFs. In the present work, CFs are determined through laboratory experiments with cultured phytoplankton and radionuclides of the concerned elements, assessing the element uptake by the phytoplankton through detection of the emitted radiation. The three CF assessed in this work were those for manganese, zinc and iodine in phytoplankton. Conservative estimates of these CF based on the present data are 40 000 L/kg for manganese, 50 000 L/kg for zinc and 180 L/kg for iodine with the phytoplankton masses referring to their dry weight

Age-related differences in adaptation during childhood: The influences of muscular power production and segmental energy flow caused by muscles

Acquisition of skillfulness is not only characterized by a task-appropriate application of muscular forces but also by the ability to adapt performance to changing task demands. Previous research suggests that there is a different developmental schedule for adaptation at the kinematic compared to the neuro-muscular level. The purpose of this study was to determine how age-related differences in neuro-muscular organization affect the mechanical construction of pedaling at different levels of the task. By quantifying the flow of segmental energy caused by muscles, we determined the muscular synergies that construct the movement outcome across movement speeds. Younger children (5-7 years; n = 11), older children (8-10 years; n = 8), and adults (22-31 years; n = 8) rode a stationary ergometer at five discrete cadences (60, 75, 90, 105, and 120 rpm) at 10% of their individually predicted peak power output. Using a forward dynamics simulation, we determined the muscular contributions to crank power, as well as muscular power delivered to the crank directly and indirectly (through energy absorption and transfer) during the downstroke and the upstroke of the crank cycle. We found significant age × cadence interactions for (1) peak muscular power at the hip joint [Wilks' Lambda = 0.441, F(8,42) = 2.65, p = 0.019] indicating that at high movement speeds children produced less peak power at the hip than adults, (2) muscular power delivered to the crank during the downstroke and the upstroke of the crank cycle [Wilks' Lambda = 0.399, F(8,42) = 3.07, p = 0.009] indicating that children delivered a greater proportion of the power to the crank during the upstroke when compared to adults, (3) hip power contribution to limb power [Wilks' Lambda = 0.454, F(8,42) = 2.54, p = 0.023] indicating a cadence-dependence of age-related differences in the muscular synergy between hip extensors and plantarflexors. The results demonstrate that in spite of a successful performance, children construct the task of pedaling differently when compared to adults, especially when they are pushed to their performance limits. The weaker synergy between hip extensors and plantarflexors suggests that a lack of inter-muscular coordination, rather than muscular power production per se, is a factor that limits children's performance ranges

Design of a Compact GaN Power Amplifier with High Efficiency and Beyond Decade Bandwidth

This letter presents a power amplifier (PA) design and network synthesis approach to achieve wideband and efficient performance with a very compact circuit size. A design method is presented in detail to convert a canonical filter-based high-order matching network to the proposed matching configuration with transistor parasitic and packaged elements absorption, and a compact passive network footprint. As a proof of concept, a prototype GaN HEMT PA is implemented. Starting from a fourth-order output network filter, the inductances and capacitance of the filter elements are re-organized to model, and thus absorb the output parasitics of the transistor, leading to a compact footprint with only four transmission lines. The measured results show that the prototype PA achieves an output power of 41.9-44.3 dBm and a 55-74 % drain efficiency, over a record-high decade bandwidth (0.35-3.55 GHz)

Sarcoidosis of the hypothalamus and pituitary stalk

We report a rare case of sarcoidosis of the hypothalamic and suprasellar region, with clinical course and the magnetic resonance imaging follow-up