AAPM medical physics practice guideline 10.a.: Scope of practice for clinical medical physics.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline (MPPG) represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiation requires specific training, skills, and techniques as described in each document. As the review of the previous version of AAPM Professional Policy (PP)-17 (Scope of Practice) progressed, the writing group focused on one of the main goals: to have this document accepted by regulatory and accrediting bodies. After much discussion, it was decided that this goal would be better served through a MPPG. To further advance this goal, the text was updated to reflect the rationale and processes by which the activities in the scope of practice were identified and categorized. Lastly, the AAPM Professional Council believes that this document has benefitted from public comment which is part of the MPPG process but not the AAPM Professional Policy approval process. The following terms are used in the AAPM's MPPGs: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances

Intertwining Relations for the Deformed D1D5 CFT

The Higgs branch of the D1D5 system flows in the infrared to a two-dimensional N=(4,4) SCFT. This system is believed to have an "orbifold point" in its moduli space where the SCFT is a free sigma model with target space the symmetric product of copies of four-tori; however, at the orbifold point gravity is strongly coupled and to reach the supergravity point one needs to turn on the four exactly marginal deformations corresponding to the blow-up modes of the orbifold SCFT. Recently, technology has been developed for studying these deformations and perturbing the D1D5 CFT off its orbifold point. We present a new method for computing the general effect of a single application of the deformation operators. The method takes the form of intertwining relations that map operators in the untwisted sector before application of the deformation operator to operators in the 2-twisted sector after the application of the deformation operator. This method is computationally more direct, and may be of theoretical interest. This line of inquiry should ultimately have relevance for black hole physics.Comment: latex, 23 pages, 3 figure

Ergocalciferol and Microcirculatory Function in Chronic Kidney Disease and Concomitant Vitamin D Deficiency: An Exploratory, Double Blind, Randomised Controlled Trial

Vitamin D deficiency and endothelial dysfunction are non-traditional risk factors for cardiovascular events in chronic kidney disease. Previous studies in chronic kidney disease have failed to demonstrate a beneficial effect of vitamin D on arterial stiffness, left ventricular mass and inflammation but none have assessed the effect of vitamin D on microcirculatory endothelial function.We conducted a randomised controlled trial of 38 patients with non diabetic chronic kidney disease stage 3-4 and concomitant vitamin D deficiency (<16 ng/dl) who received oral ergocalciferol (50,000 IU weekly for one month followed by 50,000 IU monthly) or placebo over 6 months. The primary outcome was change in microcirculatory function measured by laser Doppler flowmetry after iontophoresis of acetylcholine. Secondary endpoints were tissue advanced glycation end products, sublingual functional capillary density and flow index as well as macrovascular parameters. Parallel in vitro experiments were conducted to determine the effect of ergocalciferol on cultured human endothelial cells.Twenty patients received ergocalciferol and 18 patients received placebo. After 6 months, there was a significant improvement in the ergocalciferol group in both endothelium dependent microcirculatory vasodilatation after iontophoresis of acetylcholine (p = 0.03) and a reduction in tissue advanced glycation end products (p = 0.03). There were no changes in sublingual microcirculatory parameters. Pulse pressure (p = 0.01) but not aortic pulse wave velocity was reduced. There were no significant changes in bone mineral parameters, blood pressure or left ventricular mass index suggesting that ergocalciferol improved endothelial function independently of these parameters. In parallel experiments, expression of endothelial nitric oxide synthase and activity were increased in human endothelial cells in a dose dependent manner.Ergocalciferol improved microcirculatory endothelial function in patients with chronic kidney disease and concomitant vitamin D deficiency. This process may be mediated through enhanced expression and activity of endothelial nitric oxide synthase.Clinical trials.gov NCT00882401

Emission from the D1D5 CFT: Higher Twists

We study a certain class of nonextremal D1D5 geometries and their ergoregion emission. Using a detailed CFT computation and the formalism developed in arXiv:0906.2015 [hep-th], we compute the full spectrum and rate of emission from the geometries and find exact agreement with the gravity answer. Previously, only part of the spectrum had been reproduced using a CFT description. We close with a discussion of the context and significance of the calculation.Comment: 39 pages, 6 figures, late

Emission from the D1D5 CFT

It is believed that the D1D5 brane system is described by an 'orbifold CFT' at a special point in moduli space. We first develop a general formulation relating amplitudes in a d-dimensional CFT to absorption/emission of quanta from flat infinity. We then construct the D1D5 vertex operators for minimally coupled scalars in supergravity, and use these to compute the CFT amplitude for emission from a state carrying a single excitation. Using spectral flow we relate this process to one where we have emission from a highly excited initial state. In each case the radiation rate is found to agree with the radiation found in the gravity dual.Comment: 49 pages, latex, 6 figures; v2: reformatted for JHEP, corrected typos, and added reference

MYD88 mutations identify a molecular subgroup of diffuse large B-cell lymphoma with an unfavorable prognosis

The 2016 World Health Organization classification defines diffuse large B-cell lymphoma (DLBCL) subtypes based on Epstein-Barr virus (EBV) infection and oncogenic rearrangements of MYC/BCL2/BCL6 as drivers of lymphomagenesis. A subset of DLBCL, however, is characterized by activating mutations in MYD88/CD79B. We investigated whether MYD88/CD79B mutations could improve the classification and prognostication of DLBCL. In 250 primary DLBCL, MYD88/CD79B mutations were identified by allele-specific polymerase chain reaction or next-generationsequencing, MYC/BCL2/BCL6 rearrangements were analyzed by fluorescence in situ hybridization, and EBV was studied by EBV-encoded RNA in situ hybridization. Associations of molecular features with clinicopathologic characteristics, outcome, and prognosis according to the International Prognostic Index (IPI) were investigated. MYD88 and CD79B mutations were identified in 29.6% and 12.3%, MYC, BCL2, and BCL6 rearrangements in 10.6%, 13.6%, and 20.3%, and EBV in 11.7% of DLBCL, respectively. Prominent mutual exclusivity between EBV positivity, rearrangements, and MYD88/CD79B mutations established the value of molecular markers for the recognition of biologically distinct DLBCL subtypes. MYD88-mutated DLBCL had a significantly inferior 5-year overall survival than wild-type MYD88 DLBCL (log-rank; P=0.019). DLBCL without any of the studied aberrations had superior overall survival compared to cases carrying .1 aberrancy (log-rank; P=0.010). MYD88 mutations retained their adverse prognostic impact upon adjustment for other genetic and clinical variables by multivariable analysis and improved the prognostic performance of the IPI. This study demonstrates the clinical utility of defining MYD88-mutated DLBCL as a distinct molecular subtype with adverse prognosis. Our data call for sequence analysis of MYD88 in routine diagnostics of DLBCL to optimize classification and prognostication, and to guide the development of improved treatment strategies

In Vivo Outer Hair Cell Length Changes Expose the Active Process in the Cochlea

BACKGROUND: Mammalian hearing is refined by amplification of the sound-evoked vibration of the cochlear partition. This amplification is at least partly due to forces produced by protein motors residing in the cylindrical body of the outer hair cell. To transmit power to the cochlear partition, it is required that the outer hair cells dynamically change their length, in addition to generating force. These length changes, which have not previously been measured in vivo, must be correctly timed with the acoustic stimulus to produce amplification. METHODOLOGY/PRINCIPAL FINDINGS: Using in vivo optical coherence tomography, we demonstrate that outer hair cells in living guinea pigs have length changes with unexpected timing and magnitudes that depend on the stimulus level in the sensitive cochlea. CONCLUSIONS/SIGNIFICANCE: The level-dependent length change is a necessary condition for directly validating that power is expended by the active process presumed to underlie normal hearing

Excitations in the deformed D1D5 CFT

We perform some simple computations for the first order deformation of the D1D5 CFT off its orbifold point. It had been shown earlier that under this deformation the vacuum state changes to a squeezed state (with the further action of a supercharge). We now start with states containing one or two initial quanta and write down the corresponding states obtained under the action of deformation operator. The result is relevant to the evolution of an initial excitation in the CFT dual to the near extremal D1D5 black hole: when a left and a right moving excitation collide in the CFT, the deformation operator spreads their energy over a larger number of quanta, thus evolving the state towards the infrared.Comment: 26 pages, Latex, 4 figure

Consensus-based technical recommendations for clinical translation of renal T1 and T2 mapping MRI

To develop technical recommendations on the acquisition and post-processing of renal longitudinal (T1) and transverse (T2) relaxation time mapping. A multidisciplinary panel consisting of 18 experts in the field of renal T1 and T2 mapping participated in a consensus project, which was initiated by the European Cooperation in Science and Technology Action PARENCHIMA CA16103. Consensus recommendations were formulated using a two-step modified Delphi method. The first survey consisted of 56 items on T1 mapping, of which 4 reached the pre-defined consensus threshold of 75% or higher. The second survey was expanded to include both T1 and T2 mapping, and consisted of 54 items of which 32 reached consensus. Recommendations based were formulated on hardware, patient preparation, acquisition, analysis and reporting. Consensus-based technical recommendations for renal T1 and T2 mapping were formulated. However, there was considerable lack of consensus for renal T1 and particularly renal T2 mapping, to some extent surprising considering the long history of relaxometry in MRI, highlighting key knowledge gaps that require further work. This paper should be regarded as a first step in a long-term evidence-based iterative process towards ever increasing harmonization of scan protocols across sites, to ultimately facilitate clinical implementation

Deforming the D1D5 CFT away from the orbifold point

The D1D5 brane bound state is believed to have an `orbifold point' in its moduli space which is the analogue of the free Yang Mills theory for the D3 brane bound state. The supergravity geometry generated by D1 and D5 branes is described by a different point in moduli space, and in moving towards this point we have to deform the CFT by a marginal operator: the `twist' which links together two copies of the CFT. In this paper we find the effect of this deformation operator on the simplest physical state of the CFT -- the Ramond vacuum. The twist deformation leads to a final state that is populated by pairs of excitations like those in a squeezed state. We find the coefficients characterizing the distribution of these particle pairs (for both bosons and fermions) and thus write this final state in closed form.Comment: 30 pages, 4 figures, Late