Optimising the use of virtual and conventional simulation: a clinical and economic analysis

Background and purpose: Currently, optimal use of virtual simulation for all treatment sites is not entirely clear. This study presents data to identify specific patient groups for whom conventional simulation may be completely eliminated and replaced by virtual simulation. Sampling and method: Two hundred and sixty patients were recruited from four treatment sites (head and neck, breast, pelvis, and thorax). Patients were randomly assigned to be treated using the usual treatment process involving conventional simulation, or a treatment process differing only in the replacement of conventional plan verification with virtual verification. Data were collected on set-up accuracy at verification, and the number of unsatisfactory verifications requiring a return to the conventional simulator. A micro-economic costing analysis was also undertaken, whereby data for each treatment process episode were also collected: number and grade of staff present, and the time for each treatment episode. Results: The study shows no statistically significant difference in the number of returns to the conventional simulator for each site and study arm. Image registration data show similar quality of verification for each study arm. The micro-costing data show no statistical difference between the virtual and conventional simulation processes. Conclusions: At our institution, virtual simulation including virtual verification for the sites investigated presents no disadvantage compared to conventional simulation.

Head-SAR dependence on spectacle frame shape for operator of 450 MHz personal radio

Power deposition in the head of a user wearing metal-framed spectacles was calculated with a 450 MHz personal radio transmitting in close proximity. Peak tissue SAR in the head depended on lens shape whether circular half-rim or rectangular with 70 and 174% increases, respectively, compared to the spectacle-free case. However, localised screening occurred with square frames, with a 40% reduction of peak SAR in the eye closest to the antenna.

‘Ghosts in the Head and Ghost Towns in the Field: Ethnography and the Experience of Presence and Absence’

This article is about an anthropologist coming to terms with the field and fieldwork. In 1995, I left – was evacuated from – my fieldsite as a volcanic eruption started just as my period of fieldwork drew to a close. These eruptions dramatically and instantaneously altered life on the island of Montserrat, a British colony in the Caribbean. While Montserrat the land, and Montserratians the people, migrated and moved on with their lives, Montserrat and Montserratians were preserved in my mind and in my anthropological writings as from “back home.” Revisiting Montserrat several years into the volcano crisis, I drove through the villages and roads leading to the former capital of the island, where I had worked from. My route to this modern-day Pompeii threw up a stark contrast between absence and presence, the imagined past and the experienced present. This is understood, in part, by examining the literary work of two other travelers through Montserrat, Henry Coleridge and Pete McCarthy, both of whom have a very different experience of the place and the people.

Common input to different regions of biceps brachii long head

The purpose of the experiment was to compare the level of synchronization exhibited by pairs of motor units located within and between functionally distinct regions of the biceps brachii muscle. Pairs of single motor units were recorded from seven subjects using separate electrodes located in the lateral and medial aspects of the long head of biceps brachii. Participants were required to exert a combination of flexion and supination torques so that both motor units discharged at approximately 10 pps for a parts per thousand yen200 s and the level of motor unit synchronization could be quantified. When motor unit recordings were sufficiently stable at the completion of this synchrony task, a series of ramp contractions with multiple combinations of flexion and supination torques were performed to characterize the recruitment thresholds of the motor units. Common input strength (CIS) was significantly greater (P <0.01) for the within-region pairs of motor units (0.28 extra sync. imps/s, n = 26) than for the between-region pairs (0.13 extra sync. imps/s, n = 18), but did not differ significantly for the 12 within-region pairs from the lateral head and 14 from the medial head (0.27 vs. 0.29 extra sync. imps/s; P = 0.83). Recruitment thresholds were measured for 33 motor units, but there was only a weak association between CIS and the respective recruitment patterns for motor unit pairs (n = 9). The present investigation provides evidence of a differential distribution of synaptic input across the biceps brachii motor neuron pool, but this appears to have minimal association with the recruitment patterns for individual motor units.

Modern management of head injuries

Management of the head-injured patient is designed to prevent secondary injury and to provide the neurosurgeon with a live patient who has some hope of recovery. This review sets out the background essentials for the non-neurosurgeon dealing with the initial care of a head-injured patient.

Tumor Risks and Genotype-Phenotype-Proteotype Analysis in 358 Patients With Germline Mutations in SDHB and SDHD

Succinate dehydrogenase B (SDHB) and D (SDHD) subunit gene mutations predispose to adrenal and extraadrenal pheochromocytomas, head and neck paragangliomas (HNPGL), and other tumor types. We report tumor risks in 358 patients with SDHB (n = 295) and SDHD (n = 63) mutations. Risks of HNPGL and pheochromocytoma in SDHB mutation carriers were 29% and 52%, respectively, at age 60 years and 71% and 29%, respectively, in SDHD mutation carriers. Risks of malignant pheochromocytoma and renal tumors (14% at age 70 years) were higher in SDHB mutation carriers; 55 different mutations (including a novel recurrent exon 1 deletion) were identified. No clear genotype-phenotype correlations were detected for SDHB mutations. However, SDHD mutations predicted to result in loss of expression or a truncated or unstable protein were associated with a significantly increased risk of pheochromocytoma compared to missense mutations that were not predicted to impair protein stability (most such cases had the common p.Pro81Leu mutation). Analysis of the largest cohort of SDHB/D mutation carriers has enhanced estimates of penetrance and tumor risk and supports in silicon protein structure prediction analysis for functional assessment of mutations. The differing effect of the SDHD p.Pro81Leu on HNPGL and pheochromocytoma, risks suggests differing mechanisms of tumorigenesis in SDH-associated HNPGL and pheochromocytoma. Hum Mutat 31:41-51, 2010. (C) 2009 Wiley-Liss, Inc.

Desmoplastic Small Round Cell Tumor of Major Salivary Glands: Report of 1 Case and a Review of the Literature

Desmoplastic small round cell tumor is a rare malignant neoplasm mostly occurring in the vicinity of or within the peritoneal cavity, and is uncommon in the head and neck region. Tumor location within a major salivary gland is exceptional. We report a case of a 41-year-old Chinese man with a history of diabetes mellitus and end-stage renal failure on peritoneal dialysis with a desmoplastic small round cell tumor occurring in the left submandibular gland. Fine-needle aspiration cytology showed variably cohesive clusters of small cells with hyperchromatic nuclei and fine granular chromatin. On histology the neoplasm displayed classic features of a desmoplastic small round cell tumor with angulated nests of small round blue cells in a fibromyxoid/desmoplastic stroma. Neoplastic cells were immunoreactive for cytokeratins (AE1/3), desmin (paranuclear dot-like), WT-1 (nuclear), epithelial membrane antigen, and CD56. EWS gene translocation and EWS-WT1 gene fusion were detected by fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction, respectively. The case presented is the sixth case of and the oldest reported patient with a desmoplastic small round cell tumor occurring in a major salivary gland to date. Desmoplastic small round cell tumor should be considered in the differential diagnosis of a salivary gland neoplasm with a basaloid or small cell pattern on fine-needle aspiration cytology.