High precision determination of the terrestrial 40K abundance

Recent improvements in the precision of mass spectrometric measurements have reduced the uncertainty of K-Ar and 39Ar-40Ar ages measured on geological materials. Now the major sources of uncertainty are the uncertainties on the 40K decay constant and the absolute abundance of 40K. In order to improve on this situation we determined the abundance of the 40K isotope in terrestrial standards. A ThermoFischer Triton+ thermal ionization mass spectrometer was used for K isotope ratio measurements of the NIST K standard reference materials SRM 918b and SRM 985. Ion beams were measured in Faraday cups with amplifiers equipped with 1E10, 1E11 and 1E12 Ω resistors. Three measurement protocols were used: (A) dynamic measurement with in-run fractionation correction by normalization to the IUPAC recommended isotope ratio 41K/39K = 0.0721677; (B) total evaporation; (C) a modified total evaporation with interblock baseline measurements. Different measurement protocols were combined with different loading procedures. The best results were obtained by loading samples on single tantalum filaments with 0.1M H3PO4. The total ion yields (ionization + transmission) were tested for the evaporation procedures (B) and (C) and ranged up to 48 %. The resulting best estimate for the 40K/39K ratio is 0.000 125 116 ± 57 (2σ), corresponding to 40K/K = (1.1668 ± 8; 2σ) x 10-4.

Leaf transmission reduction using moving jaws for dynamic MLC IMRT

The aim of this work is to investigate to what extent it is possible to use the secondary collimator jaws to reduce the transmitted radiation through the multileaf collimator (MLC) during an intensity modulated radiation therapy (IMRT). A method is developed and introduced where the jaws follow the open window of the MLC dynamically (dJAW method). With the aid of three academic cases (Closed MLC, Sliding-gap, and Chair) and two clinical cases (prostate and head and neck) the feasibility of the dJAW method and the influence of this method on the applied dose distributions are investigated. For this purpose the treatment planning system Eclipse and the Research-Toolbox were used as well as measurements within a solid water phantom were performed. The transmitted radiation through the closed MLC leads to an inhomogeneous dose distribution. In this case, the measured dose within a plane perpendicular to the central axis differs up to 40% (referring to the maximum dose within this plane) for 6 and 15 MV. The calculated dose with Eclipse is clearly more homogeneous. For the Sliding-gap case this difference is still up to 9%. Among other things, these differences depend on the depth of the measurement within the solid water phantom and on the application method. In the Chair case, the dose in regions where no dose is desired is locally reduced by up to 50% using the dJAW method instead of the conventional method. The dose inside the chair-shaped region decreased up to 4% if the same number of monitor units (MU) as for the conventional method was applied. The undesired dose in the volume body minus the planning target volume in the clinical cases prostate and head and neck decreased up to 1.8% and 1.5%, while the number of the applied MU increased up to 3.1% and 2.8%, respectively. The new dJAW method has the potential to enhance the optimization of the conventional IMRT to a further step.

Does point of care prothrombin time measurement reduce the transfusion of fresh frozen plasma in patients undergoing major surgery? The POC-OP randomized-controlled trial

BACKGROUND: Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP), is often live saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. Consequently, strategies to optimize the decision to transfuse are needed. Bleeding during surgery is a dynamic process and may result in major blood loss and coagulopathy due to dilution and consumption. The indication for transfusion should be based on reliable coagulation studies. While hemoglobin levels and platelet counts are available within 15 minutes, standard coagulation studies require one hour. Therefore, the decision to administer FFP has to be made in the absence of any data. Point of care testing of prothrombin time ensures that one major parameter of coagulation is available in the operation theatre within minutes. It is fast, easy to perform, inexpensive and may enable physicians to rationally determine the need for FFP. METHODS/DESIGN: The objective of the POC-OP trial is to determine the effectiveness of point of care prothrombin time testing to reduce the administration of FFP. It is a patient and assessor blind, single center randomized controlled parallel group trial in 220 patients aged between 18 and 90 years undergoing major surgery (any type, except cardiac surgery and liver transplantation) with an estimated blood loss during surgery exceeding 20% of the calculated total blood volume or a requirement of FFP according to the judgment of the physicians in charge. Patients are randomized to usual care plus point of care prothrombin time testing or usual care alone without point of care testing. The primary outcome is the relative risk to receive any FFP perioperatively. The inclusion of 110 patients per group will yield more than 80% power to detect a clinically relevant relative risk of 0.60 to receive FFP of the experimental as compared with the control group. DISCUSSION: Point of care prothrombin time testing in the operation theatre may reduce the administration of FFP considerably, which in turn may decrease costs and complications usually associated with the administration of blood products. TRIAL REGISTRATION: NCT00656396.

3G network traffic sources measurement and analysis

In this paper, we show statistical analyses of several types of traffic sources in a 3G network, namely voice, video and data sources. For each traffic source type, measurements were collected in order to, on the one hand, gain better understanding of the statistical characteristics of the sources and, on the other hand, enable forecasting traffic behaviour in the network. The latter can be used to estimate service times and quality of service parameters. The probability density function, mean, variance, mean square deviation, skewness and kurtosis of the interarrival times are estimated by Wolfram Mathematica and Crystal Ball statistical tools. Based on evaluation of packet interarrival times, we show how the gamma distribution can be used in network simulations and in evaluation of available capacity in opportunistic systems. As a result, from our analyses, shape and scale parameters of gamma distribution are generated. Data can be applied also in dynamic network configuration in order to avoid potential network congestions or overflows. Copyright © 2013 John Wiley & Sons, Ltd.

High-Sensitive Troponin Measurement in Emergency Department Patients Presenting with Syncope: A Retrospective Analysis

OBJECTIVE To study the relevance of high-sensitive troponin measurements in the acute workup in patients admitted to the emergency department of a large university hospital due to syncope. METHODS In this retrospective study all patients admitted to the emergency department because of syncope of the Inselspital, University Hospital Bern between 01 August 2010 and 31 October 2012, with serial determination of high-sensitive troponin (baseline and three hours control) were included. Of all identified patients we obtained data on demographics, laboratory data, ECG as well as on outcome. A change in high-sensitive troponin in the three hours control of +/-30% compared to baseline was considered significant. RESULTS A total of 121 patients with a mean age of 67 years (SD 16) were included in the study. 79 patients (65%) were male and 42 (35%) were female. There was no significant difference in the median high sensitive-troponin level at baseline and in the three hours control (0.01 mcg/L [0.003 to 0.022] versus 0.011 mcg/L [0.003 to 0.022], p = 0.47). Median percent change in high-sensitive troponin level between baseline and control was 0% (-9.1 to 5). 51 patients (42%) had elevated high-sensitive troponin levels at baseline with 7 patients (6%) showing a dynamic of +/-30% change from the baseline measurement in the 3 hours control. 3 of these patients received coronary angiography due to the dynamic in high-sensitive troponin, none of whom needed intervention for coronary revascularization. CONCLUSIONS On basis of the current study, where no single patient took benefit from determination of high-sensitive troponin, measurement of cardiac troponins should be reserved for patients with syncope presenting with symptoms suggestive for the presence of an acute cardiac syndrome.

Influence of screw augmentation in posterior dynamic and rigid stabilization systems in osteoporotic lumbar vertebrae: a biomechanical cadaveric study.

STUDY DESIGN Biomechanical cadaveric study. OBJECTIVE To determine whether augmentation positively influence screw stability or not. SUMMARY OF BACKGROUND DATA Implantation of pedicle screws is a common procedure in spine surgery to provide an anchorage of posterior internal fixation into vertebrae. Screw performance is highly correlated to bone quality. Therefore, polymeric cement is often injected through specifically designed perforated pedicle screws into osteoporotic bone to potentially enhance screw stability. METHODS Caudocephalic dynamic loading was applied as quasi-physiological alternative to classical pull-out tests on 16 screws implanted in osteoporotic lumbar vertebrae and 20 screws in nonosteoporotic specimen. Load was applied using 2 different configurations simulating standard and dynamic posterior stabilization devices. Screw performance was quantified by measurement of screwhead displacement during the loading cycles. To reduce the impact of bone quality and morphology, screw performance was compared for each vertebra and averaged afterward. RESULTS All screws (with or without cement) implanted in osteoporotic vertebrae showed lower performances than the ones implanted into nonosteoporotic specimen. Augmentation was negligible for screws implanted into nonosteoporotic specimen, whereas in osteoporotic vertebrae pedicle screw stability was significantly increased. For dynamic posterior stabilization system an increase of screwhead displacement was observed in comparison with standard fixation devices in both setups. CONCLUSION Augmentation enhances screw performance in patients with poor bone stock, whereas no difference is observed for patients without osteoporosis. Furthermore, dynamic stabilization systems have the possibility to fail when implanted in osteoporotic bone.