Development and evaluation of a 44 Ti, 44 Sc radionuclide generator and labeling of biomolecules with 44 Sc and 68 Ga for PET imaging

Non-invasive molecular-imaging technologies are playing a key role in drug discovery, development and delivery. Positron Emission Tomography (PET) is such a molecular imaging technology and a powerful tool for the observation of various deceases in vivo. However, it is limited by the availability of vectors with high selectivity to the target and radionuclides with a physical half-life which matches the biological half-life of the observed process. The 68Ge/68Ga radionuclide generator makes the PET-nuclide anywhere available without an on-site cyclotron. Besides the perfect availability 68Ga shows well suited nuclide properties for PET, but it has to be co-ordinated by a chelator to introduce it in a radiopharmaceuticals.rnHowever, the physical half-life of 68Ga (67.7 min) might limit the spectrum of clinical applications of 68Ga-labelled radiodiagnostics. Furthermore, 68Ga-labelled analogues of endoradiotherapeuticals of longer biological half-live such as 90Y- or 177Lu-labeled peptides and proteins cannot be used to determine individual radiation dosimetry directly. rnThus, radionuclide generator systems providing positron emitting daughters of extended physical half-life are of renewed interest. In this context, generator-derived positron emitters with longer physical half-life are needed, such as 72As (T½ = 26 h) from the 72Se/72As generator, or 44Sc (T½ = 3.97 h) from the 44Ti/44Sc generator.rnIn this thesis the implementation of radioactive gallium-68 and scandium-44 for molecular imaging and nuclear medical diagnosis, beginning with chemical separation and purification of 44Ti as a radionuclide mother, investigation of pilot generators with different elution mode, building a prototype generator, development and investigation of post-processing of the generator eluate, its concentration and further purification, the labeling chemistry under different conditions, in vitro and in vivo studies of labeled compounds and, finally, in vivo imaging experiments are described.

The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation

A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five 'windows' for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called 'Pararectus' approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (sd 2.6) vs 0.1 mm (sd 0.3), p < 0.001; and mean gap 11.5 mm (sd 6.5) vs 0.8 mm (sd 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access.

Rheumatic heart disease: pilot study for a population-based evaluation of prevalence and cardiovascular outcomes among schoolchildren in Nepal

To evaluate a protocol for a population-based programme targeting the prevention of rheumatic heart disease (RHD) progression by early echocardiographic diagnosis of valvular lesions and timely implementation of secondary prevention.

Training in Mental Health: Evaluation of the Telephone Conference Network

The Telephone Conference Network, sponsored by The Pennsylvania State University's Coordinating Council for Health Care, is designed as a cost-effective format for providing inservice training in geriatric mental health for individuals who serve the elderly. Institutions which subscribe to the Telephone Conference Network are equipped with a conference speaker and telephone hook-up providing a two-way line of communication, and may choose from a variety of inservice programs. Mailed evaluations were completed by participants (N=73) in the "Skills to Manage Moods" program, a series of four 1-hour sessions designed to teach participants the skills needed to help patients cope with depression and to deliver the program to others. The majority of respondents reported high levels of satisfaction with the Telephone Conference Network system and the specific program in which they participated. Although 85 percent reported that they would be able to use the skills learned in the program on the job, 50 percent reported that they would not be interested in teaching these skills to others. The convenience and efficiency of the Telephone Conference Network were the most frequently mentioned strengths of the system, while the physical facilities and the program delivery format adopted by the individual institutions were the most frequently mentioned weaknesses. These data suggested several recommendations for Network subscribers and for professionals offering telephone conference programs, including ensuring optimal class enrollment and adequate physical facilities, and participant involvement in program implementation.

Applied Developmental Psychology as an Implementation of the Life-Span View of Human Development

Application of knowledge about psychological development should, ideally, be theory based. As such, these applications represent “natural ontogenetic experiments”; the results of the evaluation of such interventions feed back to the theory, helping to support, falsify, or refine the ideas from the theory which led to the particular application. Such applied developmental intervention research is central within a currently popular perspective of life-span human development. Thus, applied developmental intervention research provides critical tests of such key concepts within this life-span perspective as: plasticity; multidirectionality; the synthesis of continuous and discontinuous processes across ontogeny; contextual embeddedness; and the role of individuals as agents in their own development. This paper elucidates some of the major features of the dynamic linkage between applied developmental psychology and this view of life-span human development. Key elements of this life-span perspective and the facts of developmental intervention, as seen from this perspective, are specified. Finally, the doctoral training program at the authors' institution is presented as one example of how this link may be institutionalized in the form of graduate education.

The Laboratory Evaluation of Bio Oil Derived From Waste Resources as Extender for Asphalt Binder

A shortage of petroleum asphalt is creating opportunities for engineers to utilize alternative pavement materials. Three types of bio oils, original bio oil (OB), dewatered bio oil (DWB) and polymer-modified bio oil (PMB) were used to modify and partially replace petroleum asphalt in this research. The research investigated the procedure of producing bio oil, the rheological properties of asphalt binders modified and partially replaced by bio oil, and the mechanical performances of asphalt mixtures modified by bio oil. The analysis of variance (ANOVA) is conducted on the test results for the significance analysis. The main finding of the study includes: 1) the virgin bioasphalt is softer than the traditional asphalt binder PG 58-28 but stiffer after RTFO aging because bio oil ages much faster than the traditional asphalt binder during mixing and compaction; 2) the binder test showed that the addition of bio oil is expected to improve the rutting performance while reduce the fatigue and low temperature performance; 3) both the mass loss and the oxidation are important reasons for the bio oil aging during RTFO test; the mixture test showed that 1) most of the bio oil modified asphalt mixture had slightly higher rutting depth than the control asphalt mixture, but the difference is not statistically significant; 2) the dynamic modulus of some of the bio oil modified asphalt mixture were slightly lower than the control asphalt mixture, the E* modulus is also not statistically significant; 3) most of the bio oil modified asphalt mixture had higher fatigue lives than the control asphalt mixture; 4) the inconsistence of binder test results and mixture test results may be attributed to that the aging during the mixing and compaction was not as high as that in the RTFO aging simulation. 5) the implementation of Michigan wood bioasphalt is anticipated to reduce the emission but bring irritation on eyes and skins during the mixing and compaction.

[Implementation of a routine gradual psycho-diagnostic programme in somatic rehabilitation centres - results of a pilot study]

STUDY AIM: A pilot study was conducted to implement and evaluate a routine gradual psycho-diagnostic programme to improve diagnostics and treatment of mental disorders in somatic rehabilitation centres. First of all, implementation strategies were acquired in trainings together with psychologists and physicians. The psycho-diagnostic programme consists of a screening instrument (PHQ-9) designed to permit time-effective detection of comorbid mental disorders. Besides evaluation of the training, the aim of the study was to analyze the extent to which it is possible to implement the routine gradual psycho-diagnostic programme in practice. Additionally, it was intended to identify beneficial and obstructive conditions for implementation. METHODOLOGY: The pilot study was conducted in two orthopaedic and one cardiological rehabilitation centre. The training was evaluated directly after its completion using a questionnaire. Three months after its implementation, the introduction of the psycho-diagnostic programme was evaluated using interviews with n=11 physicians and psychologists. RESULTS: The training was rated positively by the participants . Implementation of the entire gradual psycho-diagnostic programme was possible in one centre and to some degree in the other two. Beneficial for implementation were a frank organisational climate, sufficient time resources, and physicians' biopsychosocial understanding of disease. A dismissive attitude towards psycho-diagnostics, little communication between staff members, little perceived advantage for one's own work and fear to stigmatise patients by psychiatric diagnoses were obstructive. CONCLUSION: Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.

One-year evaluation of a neonatal screening program for cystic fibrosis in Switzerland

BACKGROUND From January 2011 onward, the Swiss newborn screening (NBS) program has included a test for cystic fibrosis (CF). In this study, we evaluate the first year of implementation of the CF-NBS program. METHODS The CF-NBS program consists of testing in two steps: a heel prick sample is drawn (= Guthrie test) for measurement of immunoreactive trypsinogen (IRT) and for DNA screening. All children with a positive screening test are referred to a CF center for further diagnostic testing (sweat test and genetic analysis). After assessment in the CF center, the parents are given a questionnaire. All the results of the screening process and the parent questionnaires were centrally collected and evaluated. RESULTS In 2011, 83 198 neonates were screened, 84 of whom (0.1%) had a positive screening result and were referred to a CF center. 30 of these 84 infants were finally diagnosed with CF (positive predictive value: 35.7%). There was an additional infant with CF and meconium ileus whose IRT value was normal. The 31 diagnosed children with CF correspond to an incidence of 1 : 2683. The average time from birth to genetically confirmed diagnosis was 34 days (range: 13-135). 91% of the parents were satisfied that their child had undergone screening. All infants receiving a diagnosis of CF went on to receive further professional care in a CF center. CONCLUSION The suggested procedure for CF-NBS has been found effective in practice; there were no major problems with its implementation. It reached high acceptance among physicians and parents.

Evaluation einer selbstkonzeptfördernden Intervention im Sportunterricht.

Vor dem Hintergrund, dass es bis anhin nicht gelungen ist, empirische Evidenz für das pädagogische Postulat der Persönlichkeitsentwicklung durch Sport vorzulegen, haben sich im letzten Jahrzehnt diverse Forschungsgruppen der Selbstkonzeptentwicklung im Sport (-unterricht) angenommen (z. B. Neuber, 2007). In zunehmendem Masse werden dabei quasi-experimentelle Interventionsstudien (eine Übersicht findet sich z. B. bei Fox, 2000) durchgeführt, wobei allerdings häufig auf die Evaluation der Implementationsgenauigkeit verzichtet wird. Die vorliegende Studie nimmt sich diesem Defizit an und untersucht im Rahmen der sportpädagogischen Evaluationsforschung sowohl die Implementation als auch die Wirksamkeit einer selbstkonzeptfördernden Intervention im Sportunterricht. Es wird überprüft, ob die Implementation einer individuellen Bezugsnormorientierung (IBNO) von Lehrpersonen zu positiven Veränderungen im sportbezogenen Fähigkeitsselbstkonzept (SFSK) von Schülerinnen und Schülern führt. Die Lehrpersonen von 5. Primarklassen der Versuchsgruppe wurden während der zwanzigwöchigen Intervention (quasi-experimentelle Längsschnittstudie mit Versuchs- und Kontrollgruppe) aufgefordert, den Sportunterricht anhand einer individuellen Bezugsnormorientierung zu gestalten. Die Prüfung der schülerperzipierten IBNO und des SFSK (NSchülerInnen = 203, Alter: MAlter = 12.0, 46.8% weiblich, nVG = 96, nKG = 107) erfolgte mittels zweifaktorieller Varianzanalyse mit Messwiederholung. Zudem wird die Häufigkeit der Nutzung eines individuellen Lernjournals durch die Schülerinnen und Schüler analysiert. Das Lernjournal wurde im Mittel 42.6 mal (SD = 12.2) im Unterricht benutzt. Die schülerperzipierte IBNO und das SFSK der Versuchsgruppe nehmen im Verlauf der Intervention im Vergleich zur Kontrollgruppe zu (sig. Interaktionseffekt; IBNO: F(1,201) = 6.35, p = .012, η2 = .031; SFSK: F(1,201) = 6.44, p = .012, η2 = .031). Die Ergebnisse zeigen, dass die Intervention umgesetzt wurde und zu den beabsichtigten Wirkungen führte. Dies deutet auf die Möglichkeiten einer IBNO zur Selbstkonzeptförderung im Sportunterricht und auf die Relevanz der Implementationsevaluation zur Erklärung von Programmwirkungen hin.

KrigInv: An efficient and user-friendly implementation of batch-sequential inversion strategies based on kriging

Several strategies relying on kriging have recently been proposed for adaptively estimating contour lines and excursion sets of functions under severely limited evaluation budget. The recently released R package KrigInv 3 is presented and offers a sound implementation of various sampling criteria for those kinds of inverse problems. KrigInv is based on the DiceKriging package, and thus benefits from a number of options concerning the underlying kriging models. Six implemented sampling criteria are detailed in a tutorial and illustrated with graphical examples. Different functionalities of KrigInv are gradually explained. Additionally, two recently proposed criteria for batch-sequential inversion are presented, enabling advanced users to distribute function evaluations in parallel on clusters or clouds of machines. Finally, auxiliary problems are discussed. These include the fine tuning of numerical integration and optimization procedures used within the computation and the optimization of the considered criteria.

In vitro accuracy evaluation of image-guided robot system for direct cochlear access

HYPOTHESIS A previously developed image-guided robot system can safely drill a tunnel from the lateral mastoid surface, through the facial recess, to the middle ear, as a viable alternative to conventional mastoidectomy for cochlear electrode insertion. BACKGROUND Direct cochlear access (DCA) provides a minimally invasive tunnel from the lateral surface of the mastoid through the facial recess to the middle ear for cochlear electrode insertion. A safe and effective tunnel drilled through the narrow facial recess requires a highly accurate image-guided surgical system. Previous attempts have relied on patient-specific templates and robotic systems to guide drilling tools. In this study, we report on improvements made to an image-guided surgical robot system developed specifically for this purpose and the resulting accuracy achieved in vitro. MATERIALS AND METHODS The proposed image-guided robotic DCA procedure was carried out bilaterally on 4 whole head cadaver specimens. Specimens were implanted with titanium fiducial markers and imaged with cone-beam CT. A preoperative plan was created using a custom software package wherein relevant anatomical structures of the facial recess were segmented, and a drill trajectory targeting the round window was defined. Patient-to-image registration was performed with the custom robot system to reference the preoperative plan, and the DCA tunnel was drilled in 3 stages with progressively longer drill bits. The position of the drilled tunnel was defined as a line fitted to a point cloud of the segmented tunnel using principle component analysis (PCA function in MatLab). The accuracy of the DCA was then assessed by coregistering preoperative and postoperative image data and measuring the deviation of the drilled tunnel from the plan. The final step of electrode insertion was also performed through the DCA tunnel after manual removal of the promontory through the external auditory canal. RESULTS Drilling error was defined as the lateral deviation of the tool in the plane perpendicular to the drill axis (excluding depth error). Errors of 0.08 ± 0.05 mm and 0.15 ± 0.08 mm were measured on the lateral mastoid surface and at the target on the round window, respectively (n =8). Full electrode insertion was possible for 7 cases. In 1 case, the electrode was partially inserted with 1 contact pair external to the cochlea. CONCLUSION The purpose-built robot system was able to perform a safe and reliable DCA for cochlear implantation. The workflow implemented in this study mimics the envisioned clinical procedure showing the feasibility of future clinical implementation.

Formative Evaluation of the "Time Twisters": A Comic Book Based Obesity Prevention Curriculum for Elementary School Students

Introduction: Obesity is a public health problem, particularly in Hispanic children. Alternative media channels may offer the potential to motivate children to engage in health promoting behaviors. A comic book, “Time Twisters”, was developed to impact screen time use, physical activity, and dietary behavior for elementary school children and evaluated for acceptability and feasibility prior to implementation in a multi-component physical activity intervention. [See PDF for complete abstract]

The Development and Implementation of an Anthropomorphic Head Phantom for the Assessment of Proton Therapy Treatment Procedures

Proton therapy has become an increasingly more common method of radiation therapy, with the dose sparing to distal tissue making it an appealing option, particularly for treatment of brain tumors. This study sought to develop a head phantom for the Radiological Physics Center (RPC), the first to be used for credentialing of institutions wishing to participate in clinical trials involving brain tumor treatment of proton therapy. It was hypothesized that a head phantom could be created for the evaluation of proton therapy treatment procedures (treatment simulation, planning, and delivery) to assure agreement between the measured dose and calculated dose within ±5%/3mm with a reproducibility of ±3%. The relative stopping power (RSP) and Hounsfield Units (HU) were measured for potential phantom materials and a human skull was cast in tissue-equivalent Alderson material (RLSP 1.00, HU 16) with anatomical airways and a cylindrical hole for imaging and dosimetry inserts drilled into the phantom material. Two treatment plans, proton passive scattering and proton spot scanning, were created. Thermoluminescent dosimeters (TLDs) and film were loaded into the phantom dosimetry insert. Each treatment plan was delivered three separate times. Each treatment plan passed our 5%/3mm criteria, with a reproducibility of ±3%. The hypothesis was accepted and the phantom was found to be suitable for remote audits of proton therapy treatment facilities.

Evaluation of deformable image registration for improved 4D CT-derived ventilation for image guided radiotherapy

Recent treatment planning studies have demonstrated the use of physiologic images in radiation therapy treatment planning to identify regions for functional avoidance. This image-guided radiotherapy (IGRT) strategy may reduce the injury and/or functional loss following thoracic radiotherapy. 4D computed tomography (CT), developed for radiotherapy treatment planning, is a relatively new imaging technique that allows the acquisition of a time-varying sequence of 3D CT images of the patient's lungs through the respiratory cycle. Guerrero et al. developed a method to calculate ventilation imaging from 4D CT, which is potentially better suited and more broadly available for IGRT than the current standard imaging methods. The key to extracting function information from 4D CT is the construction of a volumetric deformation field that accurately tracks the motion of the patient's lungs during the respiratory cycle. The spatial accuracy of the displacement field directly impacts the ventilation images; higher spatial registration accuracy will result in less ventilation image artifacts and physiologic inaccuracies. Presently, a consistent methodology for spatial accuracy evaluation of the DIR transformation is lacking. Evaluation of the 4D CT-derived ventilation images will be performed to assess correlation with global measurements of lung ventilation, as well as regional correlation of the distribution of ventilation with the current clinical standard SPECT. This requires a novel framework for both the detailed assessment of an image registration algorithm's performance characteristics as well as quality assurance for spatial accuracy assessment in routine application. Finally, we hypothesize that hypo-ventilated regions, identified on 4D CT ventilation images, will correlate with hypo-perfused regions in lung cancer patients who have obstructive lesions. A prospective imaging trial of patients with locally advanced non-small-cell lung cancer will allow this hypothesis to be tested. These advances are intended to contribute to the validation and clinical implementation of CT-based ventilation imaging in prospective clinical trials, in which the impact of this imaging method on patient outcomes may be tested.

Skills training and social influences for violence prevention in middle schools: A curriculum evaluation

This pilot study evaluated the effect of skills training and of social influences on self-reported aggressive behavior in a sample of 239 sixth-grade students. The effect of two intervention groups and one control group were compared. In the first intervention group, a 15-session, violence-prevention curriculum was taught by the teacher. In the second intervention group, the same curriculum was taught by the teacher with the assistance of peer leaders trained to modify social norms about violence. The control group was evaluated but did not receive any training. The design included four schools. In two schools, three classes were assigned to one of the two interventions or to the control group. In the other two schools, two classes were assigned to either intervention (teacher only) or control. Students were evaluated before and after the implementation of the curriculum using a standardized questionnaire.^ The primary outcome was the effect of the curriculum and peer leaders on self-reported aggressive behaviors. The secondary outcome was their impact on intervening variables: knowledge about violence, conflict-resolution skills, self-efficacy, and attitudes.^ The intervention had a moderate effect on reducing self-reported aggressive behaviors among boys in two of the six classes that received the curriculum. Both classes with peer leaders reduced their aggressive behavior, but this reduction was significant in only one. A peer leader selection problem could probably explain this lack of effect.^ In three of the four schools, both interventions had an overall significant effect on increasing knowledge about violence and skills to reduce violence. Students also developed a more negative attitude toward violence after the intervention. As hypothesized, attitude change was stronger among students from the teacher plus peer leader group. No intervention effect was observed on self-efficacy nor on attitudes toward skills to reduce violence. Limitations of the study and implications for violence prevention in schools are discussed. ^