Development of a novel experimental model to investigate radiobiological implications of respiratory motion in advanced radiotherapy

Respiratory motion introduces complex spatio-temporal variations in the dosimetry of radiotherapy. There is a paucity of literature investigating the radiobiological consequences of intrafraction motion and concerns regarding the impact of movement when applied to cancer cell lines in vitro exist. We have addressed this by developing a novel model which accurately replicates respiratory motion under experimental conditions to allow clinically relevant irradiation of cell lines. A bespoke phantom and motor driven moving platform was adapted to accommodate flasks containing medium and cells in order to replicate respiratory motion using varying frequencies and amplitude settings. To study this effect on cell survival in vitro, dose response curves were determined for human lung cancer cell lines H1299 and H460 exposed to a uniform 6 MV radiation field under moving or stationary conditions. Cell survival curves showed no significant difference between irradiation at different dose points for these cell lines in the presence or absence of motion. These data indicate that motion of unshielded cells in vitro does not affect cell survival in the presence of uniform irradiation. This model provides a novel research platform to investigate the radiobiological consequences of respiratory motion in radiotherapy.

Detached-Eddy Simulation of a Louver-Cooling Scheme for Turbine Blades

The performance of a louver-cooling scheme on a flat plate was analyzed using a detached-eddy-simulation turbulence model. It was assumed that the louver-cooling scheme was tested in a wind tunnel with the mainstream flow velocity of 20 m/s, equivalent to a Reynolds number of 16,200, based on the jet diameter. Turbulence closure was achieved by a realizable k-e-based detached-eddy-simulation turbulence model. Solutions of two blowing ratios of 0.5 and 1 were successfully obtained by running parallel on 16 nodes on a computer cluster. The flowfields were found to be highly unsteady and oscillatory in nature, with the maximum fluctuation of the adiabatic effectiveness as high as 15% of the time-averaged value. It is shown that the fluctuations in the adiabatic effectiveness are mainly caused by the spanwise fluctuation of the coolant jet and the unsteady vortical structures created by the interaction of the jet and the mainstream.

Unsteady Simulations of a Film Cooling Flow from an Inclined Cylindrical Jet

Film cooling is extensively used to provide protection against the severe thermal environment in gas turbine engines. Most of the computational studies on film cooling flow have been done using steady Reynolds-averaged Navier–Stokes calculation procedures. However, the flowfield associated with a jet in a crossflow is highly unsteady and complex with different types of vortical structures. In this paper, a computational investigation about the unsteady phenomena of a jet in a crossflow is performed using detached eddy simulation. Detailed computation of a single row of 35 deg round holes on a flat plate has been obtained for a 1.0 blowing ratio and a 2.0 density ratio. First, time-step size, grid resolution, and computational domain tests for an unsteady simulation have been conducted. Comparison between the results of unsteady Reynolds-averaged Navier–Stokes calculation, detached eddy simulation, and large eddy simulation is also performed. Comparison of the time-averaged detached eddy simulation prediction with the measured film-cooling effectiveness shows that the detached eddy simulation prediction is reasonable. From present detached eddy simulations, the influential coherent vortical structures of a film cooling flow can be seen. The unsteady physics of jet in a crossflow interactions and a jet liftoff in film cooling flows have been explained.

Numerical Study of Film Cooling Scheme on a Blunt-Nosed Body in Hypersonic Flow

In hypersonic flight, the prediction of aerodynamic heating and the construction of a proper thermal protection system (TPS) are significantly important. In this study, the method of a film cooling technique, which is already the state of the art in cooling of gas turbine engines, is proposed for a fully reusable and active TPS. Effectiveness of the film cooling scheme to reduce convective heating rates for a blunt-nosed spacecraft flying at Mach number 6.56 and 40 deg angle of attack is investigated numerically. The inflow boundary conditions used the standard values at an altitude of 30 km. The computational domain consists of infinite rows of film cooling holes on the bottom of a blunt-nosed slab. Laminar and several turbulent calculations have been performed and compared. The influence of blowing ratios on the film cooling effectiveness is investigated. The results exhibit that the film cooling technique could be an effective method for an active cooling of blunt-nosed bodies in hypersonic flows.

The experiences of palliative care health service provision for people with non-malignant respiratory disease and their caregivers: an all-Ireland study

Aim: To explore the perception of palliative care provision for people with non-malignant respiratory disease from the perspective of bereaved caregivers.

Background: It is recognized that the majority of patients diagnosed with a malignant disease will have access to palliative care provision. However, it is less clear if the same standards of palliative care are available to those with non-malignant respiratory disease in Northern Ireland and the Republic of Ireland.

Design: A qualitative study based on broad interpretivism.

Methods: This research is a PhD study funded by the Department of Education and Learning in Northern Ireland (awarded February 2011). Data collection will consist of two stages; interviews with 20 bereaved caregivers of people who have died 3–18 months previously with a diagnosis of non-malignant respiratory disease and four focus groups with healthcare professionals involved in the care of this client group. This study will be carried out at four healthcare sites across the Island of Ireland. The data will be analysed using thematic content analysis. Research Ethics committee approval was obtained (March 2012).

Discussion: This research will explore the experiences of patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and Bronchiectasis and their caregivers from the perspective of the bereaved caregiver. The outcomes of this study will provide a critical first step in the development of more responsive palliative care for this client group and have important implications for future practice and policy in the palliative care provided to this client group.

Host cell kinases, α5 and β1 integrins, and Rac1 signalling on the microtubule cytoskeleton are important for non-typable Haemophilus influenzae invasion of respiratory epithelial cells

Non-typable Haemophilus influenzae (NTHi) is a common commensal of the human nasopharynx, but causes opportunistic infection when the respiratory tract is compromised by infection or disease. The ability of NTHi to invade epithelial cells has been described, but the underlying molecular mechanisms are poorly characterized. We previously determined that NTHi promotes phosphorylation of the serine-threonine kinase Akt in A549 human lung epithelial cells, and that Akt phosphorylation and NTHi cell invasion are prevented by inhibition of phosphoinositide 3-kinase (PI3K). Because PI3K-Akt signalling is associated with several host cell networks, the purpose of the current study was to identify eukaryotic molecules important for NTHi epithelial invasion. We found that inhibition of Akt activity reduced NTHi internalization; differently, bacterial entry was increased by phospholipase C?1 inhibition but was not affected by protein kinase inhibition. We also found that a5 and ß1 integrins, and the tyrosine kinases focal adhesion kinase and Src, are important for NTHi A549 cell invasion. NTHi internalization was shown to be favoured by activation of Rac1 guanosine triphosphatase (GTPase), together with the guanine nucleotide exchange factor Vav2 and the effector Pak1. Also, Pak1 might be associated with inactivation of the microtubule destabilizing agent Op18/stathmin, to facilitate microtubule polymerization and NTHi entry. Conversely, inhibition of RhoA GTPase and its effector ROCK increased the number of internalized bacteria. Src and Rac1 were found to be important for NTHi-triggered Akt phosphorylation. An increase in host cyclic AMP reduced bacterial entry, which was linked to protein kinase A. These findings suggest that NTHi finely manipulates host signalling molecules to invade respiratory epithelial cells.

Pneumonia and lower respiratory infections in nursing home residents:Predictors of hospitalization and mortality

OBJECTIVES: To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs). DESIGN: A nested cohort study. SETTING: Nine nursing homes in southern Ontario. PARTICIPANTS: Three hundred fifty-three nursing home residents with LRIs (enrolled in the control arm of a clinical trial). MEASUREMENTS: Comorbidities, vaccination status, age, health-related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days. RESULTS: Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P

Agreement between self-report and medical records on signs and symptoms of respiratory illness

Background: Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. Aims: To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Methods: Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Results: Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa=0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged =5 years) and adults. Conclusions: Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients. © 2012 Primary Care Respiratory Society UK. All rights reserved.