Accuracy of chest computed tomography in distinguishing cystic pleuropulmonary blastoma from benign congenital lung malformations in children

Importance: The ability of computed tomography (CT) to distinguish between benign congenital lung malformations and malignant cystic pleuropulmonary blastomas (PPBs) is unclear. Objective: To assess whether chest CT can detect malignant tumors among postnatally detected lung lesions in children. Design, Setting, and Participants: This retrospective multicenter case-control study used a consortium database of 521 pathologically confirmed primary lung lesions from January 1, 2009, through December 31, 2015, to assess diagnostic accuracy. Preoperative CT scans of children with cystic PPB (cases) were selected and age-matched with CT scans from patients with postnatally detected congenital lung malformations (controls). Statistical analysis was performed from January 18 to September 6, 2020. Preoperative CT scans were interpreted independently by 9 experienced pediatric radiologists in a blinded fashion and analyzed from January 24, 2019, to September 6, 2020. Main Outcomes and Measures: Accuracy, sensitivity, and specificity of CT in correctly identifying children with malignant tumors. Results: Among 477 CT scans identified (282 boys [59%]; median age at CT, 3.6 months [IQR, 1.2-7.2 months]; median age at resection, 6.9 months [IQR, 4.2-12.8 months]), 40 cases were extensively reviewed; 9 cases (23%) had pathologically confirmed cystic PPB. The median age at CT was 7.3 months (IQR, 2.9-22.4 months), and median age at resection was 8.7 months (IQR, 5.0-24.4 months). The sensitivity of CT for detecting PPB was 58%, and the specificity was 83%. High suspicion for malignancy correlated with PPB pathology (odds ratio, 13.5; 95% CI, 2.7-67.3; P = .002). There was poor interrater reliability (κ = 0.36 [range, 0.06-0.64]; P \u3c .001) and no significant difference in specific imaging characteristics between PPB and benign cystic lesions. The overall accuracy rate for distinguishing benign vs malignant lesions was 81%. Conclusions and Relevance: This study suggests that chest CT, the current criterion standard imaging modality to assess the lung parenchyma, may not accurately and reliably distinguish PPB from benign congenital lung malformations in children. In any cystic lung lesion without a prenatal diagnosis, operative management to confirm pathologic diagnosis is warranted

Longitudinal phase space manipulation in energy recovering linac-driven free-electron lasers

Energy recovering an electron beam after it has participated in a free-electron laser (FEL) interaction can be quite challenging because of the substantial FEL-induced energy spread and the energy anti-damping that occurs during deceleration. In the Jefferson Lab infrared FEL driver-accelerator, such an energy recovery scheme was implemented by properly matching the longitudinal phase space throughout the recirculation transport by employing the so-called energy compression scheme. In the present paper,after presenting a single-particle dynamics approach of the method used to energy-recover the electron beam, we report on experimental validation of the method obtained by measurements of the so-called "compression efficiency" and "momentum compaction" lattice transfer maps at different locations in the recirculation transport line. We also compare these measurements with numerical tracking simulations.Comment: 31 pages, 13 figures, submitted to Phys. Rev. Special Topics A&

An emittance measurement system for a wide range of bunch charges

As a part of the emittance measurements planned for the FEL injector at the Thomas Jefferson National Accelerator Facility (Jefferson Lab), the authors have developed an emittance measurement system that covers the wide dynamic range of bunch charges necessary to fully characterize the high-DC-voltage photocathode gun. The measurements are carried out with a variant of the classical two-slit method using a slit to sample the beam in conjunction with a wire scanner to measure the transmitted beam profile. The use of commercial, ultra-low noise picoammeters makes it possible to cover the wide range of desired bunch charges, with the actual measurements made over the range of 0.25 pC to 125 pC. The entire system, including its integration into the EPICS control system, is discussed

Design Thinking: Project Portfolio Management and Simulation – A Creative Mix for Research

This paper takes de Bono’s explanation of ‘design thinking’ as the starting point for a report on a doctoral research project that began with a conventional ‘why?’ question, and then, instead of looking for an ‘explanation’, chose to look forward in time to establish an understanding of ‘how to’ think differently about a recurring problem. The catalyst for this work was observation of otherwise competent managers making desperately wrong decisions when good decision making was crucial to their company’s future. The initial choice to ‘look forward’ when designing the research strategy was made well before there was a clear understanding of what was being observed. Given that trajectory, this paper explores the process by which a simulation was created and then used in conjunction with a comparatively new approach to data collection (Explanation looks backwards and design looks forward [1].)

Feasibility study of the National Autistic Society EarlyBird parent support programme

The EarlyBird programme is a group-based psychoeducation intervention for parents of young children with autism. Although it is widely used in the United Kingdom, the evidence base for the programme is very limited. Using a mixed method, non-randomised research design, we aimed to test (1) the acceptability of the research procedures (recruitment, retention, suitability of measures), (2) the parental acceptability of EarlyBird (attendance, views of the programme, perceived changes) and (3) the facilitator acceptability of EarlyBird (fidelity, views of the programme, perceived changes). Seventeen families with a 2- to 5-year-old autistic child and 10 EarlyBird facilitators took part. Pre- and post-intervention assessment included measures of the child’s autism characteristics, cognitive ability, adaptive behaviour, emotional and behavioural problems and parent-reported autism knowledge, parenting competence, stress and wellbeing. Semi-structured interviews were completed at post-intervention with parents and facilitators. For those involved in the study, the research procedures were generally acceptable, retention rates were high and the research protocol was administered as planned. Generally, positive views of the intervention were expressed by parents and facilitators. Although the uncontrolled, within-participant design does not allow us to test for efficacy, change in several outcome measures from pre- to post-intervention was in the expected direction. Difficulties were encountered with recruitment (opt-in to the groups was ~56% and opt-in to the research was 63%), and strategies to enhance recruitment need to be built into any future trial. These findings should be used to inform protocols for pragmatic, controlled trials of EarlyBird and other group-based interventions for parents with young autistic children

Disciplined into good conduct : Gender constructions of users in a municipal psychiatric context in Sweden

Aims and objectives To examine how gendered discursive norms and notions of masculinity and femininity were (re)produced in professional conversations about users of long‐term municipality psychiatric care. Focus is on the staff’s use of language in relation to gender constructions. Background Psychiatric care in Sweden has undergone tremendous changes in recent decades from custodian care in large hospitals to a care mainly located in a municipal context. People who need psychiatric care services often live in supporting houses. In municipal psychiatric care, staff conduct weekly professional meetings to discuss daily matters and the users’ needs. Official reports of the Swedish government have shown that staff in municipal care services treat disabled women and men differently. Studies exploring gender in relation to users of long‐term psychiatric care in municipalities have problematised the care and how staff, through language, construct users’ gender. Therefore, language used by staff is a central tool for ascribing different gender identities of users. Design The content of speech derived from audio recordings were analysed using Foucauldian discursive analysis. The COREQ checklist was used in this article. Results The results indicate that by relying on gender discourses, staff create a conditional care related to how the users should demonstrate good conduct. In line with that, an overall discourse was created: Disciplined into good conduct. It was underpinned by three discourses inherent therein: The unreliable drinker and the confession, Threatened dignity, Doing different femininities. Conclusion The community psychiatric context generates a discourse of conduct in which staff, via spoken language (re)produces gendered patterns and power imbalances as a means to manage daily work routines. Such practices of care, in which constant, nearly panoptic, control despite the intention to promote autonomy, urgently require problematising current definitions of good conduct and normality.Peer reviewe

Modeling of oropharyngeal articulatory adaptation to compensate for the acoustic effects of nasalization

Hypernasality is one of the most detrimental speech disturbances that lead to declines of speech intelligibility. Velopharyngeal inadequacy, which is associated with anatomic defects such as cleft palate or neuromuscular disorders that affect velopharygneal function, is the primary cause of hypernasality. A simulation study by Rong and Kuehn [J. Speech Lang. Hear. Res. 55(5), 1438–1448 (2012)] demonstrated that properly adjusted oropharyngeal articulation can reduce nasality for vowels synthesized with an articulatory model [Mermelstein, J. Acoust. Soc. Am. 53(4), 1070–1082 (1973)]. In this study, a speaker-adaptive articulatory model was developed to simulate speaker-customized oropharyngeal articulatory adaptation to compensate for the acoustic effects of nasalization on /a/, /i/, and /u/. The results demonstrated that (1) the oropharyngeal articulatory adaptation effectively counteracted the effects of nasalization on the second lowest formant frequency (F2) and partially compensated for the effects of nasalization on vowel space (e.g., shifting and constriction of vowel space) and (2) the articulatory adaptation strategies generated by the speaker-adaptive model might be more efficacious for counteracting the acoustic effects of nasalization compared to the adaptation strategies generated by the standard articulatory model in Rong and Kuehn. The findings of this study indicated the potential of using oropharyngeal articulatory adaptation as a means to correct maladaptive articulatory behaviors and to reduce nasalit

A High-Average-Power Free Electron Laser for Microfabrication and Surface Applications

CEBAF has developed a comprehensive conceptual design of an industrial user facility based on a kilowatt ultraviolet (UV) (160-1000 mm) and infrared (IR) (2-25 micron) free electron laser (FEL) driven by a recirculating, energy recovering 200 MeV superconducting radio frequency (SRF) accelerator. FEL users, CEBAF's partners in the Lase Processing Consortium, including AT&T, DuPont, IBM, Northrop Grumman, 3M, and Xerox, are developing applications such as metal, ceramic, and electronic material micro-fabrication and polymer and metal surface processing, with the overall effort leading to later scale-up to industrial systems at 50-100 kW. Representative applications are described. The proposed high-average-power FEL overcomes limitations of conventional laser sources in available power, cost-effectiveness, tunability, and pulse structure