Self-reported quality of life of 8-12 year old children with cerebral palsy: a cross-sectional European Study

Background

Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population.

Methods

1174 children aged 8–12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population.

Findings

Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7·6, 95% CI 2·7–12·4); intellectual impairment with reduced mean for moods and emotions (3·7, 1·5–5·9) and autonomy (3·3, 0·9–5·7); and speech difficulties with reduced mean for relationships with parents (4·5, 1·9–7·1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible.

Interpretation

Parents can be reassured that most children aged 8–12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.

Optimisation of radiotherapy for carcinoma of the parotid gland: a comparison of conventional, three-dimensional conformal, and intensity-modulated techniques

Background and purpose: To compare external beam radiotherapy techniques for parotid gland tumours using conventional radiotherapy (RT), three-dimensional conformal radiotherapy (3DCRT), and intensity-modulated radiotherapy (IMRT). To optimise the IMRT techniques, and to produce an IMRT class solution.Materials and methods: The planning target volume (PTV), contra-lateral parotid gland, oral cavity, brain-stem, brain and cochlea were outlined on CT planning scans of six patients with parotid gland tumours. Optimised conventional RT and 3DCRT plans were created and compared with inverse-planned IMRT dose distributions using dose-volume histograms. The aim was to reduce the radiation dose to organs at risk and improve the PTV dose distribution. A beam-direction optimisation algorithm was used to improve the dose distribution of the IMRT plans, and a class solution for parotid gland IMRT was investigated.Results: 3DCRT plans produced an equivalent PTV irradiation and reduced the dose to the cochlea, oral cavity, brain, and other normal tissues compared with conventional RT. IMRT further reduced the radiation dose to the cochlea and oral cavity compared with 3DCRT. For nine- and seven-field IMRT techniques, there was an increase in low-dose radiation to non-target tissue and the contra-lateral parotid gland. IMRT plans produced using three to five optimised intensity-modulated beam directions maintained the advantages of the more complex IMRT plans, and reduced the contra-lateral parotid gland dose to acceptable levels. Three- and four-field non-coplanar beam arrangements increased the volume of brain irradiated, and increased PTV dose inhomogeneity. A four-field class solution consisting of paired ipsilateral coplanar anterior and posterior oblique beams (15, 45, 145 and 170o from the anterior plane) was developed which maintained the benefits without the complexity of individual patient optimisation.Conclusions: For patients with parotid gland tumours, reduction in the radiation dose to critical normal tissues was demonstrated with 3DCRT compared with conventional RT. IMRT produced a further reduction in the dose to the cochlea and oral cavity. With nine and seven fields, the dose to the contra-lateral parotid gland was increased, but this was avoided by optimisation of the beam directions. The benefits of IMRT were maintained with three or four fields when the beam angles were optimised, but were also achieved using a four-field class solution. Clinical trials are required to confirm the clinical benefits of these improved dose distributions.

Interaction of High Intensity Picosecond Laser Pulses with Large Pre-formed Plasmas

The interaction of short (1-2 ps) laser pulses with solid targets at irradiances of over 1016 Wcm~2 , in the presence of a substantial prepulse has been investigated. High absorption of laser energy is found even at high angles of incidence, with evidence for a resonance absorption peak being found for S, P, and circular polarizations. It is considered that this may be a result of refraction and beam filamentation, which causes loss of distinct polarization. Measurements of hard X-ray emission (~ 100 keV) confirm a resonance absorption type peak at 45-50°, again for all three cases. Typically, 5-15% of the incident light is back-reflected by stimulated Brillouin scatter, with spatially resolved spectra showing evidence of beam hot-spots at high intensity. The possibility that filamentation and refraction of the beam can explain the lack of polarization dependence in the absorption and hard X-ray emission data is discussed.

Antennas for over-body-surface communication at 2.45 GHz

In this paper, the on-body performance of a range of wearable antennas was investigated by measuring vertical bar S-21 vertical bar path gain between two devices mounted on tissue-equivalent numerical and experimental phantoms, representative of human muscle tissue at 2.45 GHz. In particular, the study focused on the performance of a compact higher mode microstrip patch antenna (HMMPA) with a profile as low as lambda/20. The 5- and 10-mm-high HMMPA prototypes had an impedance bandwidth of 6.7% and 8.6%, respectively, sufficient for the operating requirements of the 2.45-GHz industrial, scientific, and medical (ISM) band and both antennas offered 11-dB higher path gain compared to a fundamental-mode microstrip patch antenna. It was also dernonstrated that a 7-dB improvement in path gain can be obtained for a fundamental-mode patch through the addition of a shortening wall. Notably, on-body HMMPA performance was comparable to a quarter wave monopole antenna on the same size of ground-plane, mounted normal to the tissue surface, indicating that the low-profile and physically more robust antenna is a promising solution for bodyworn antenna applications.

An experimental investigation into the influence of user state and environment on fading characteristics in wireless body area networks at 2.45 GHz

Using seven strategically placed, time-synchronized bodyworn receivers covering the head, upper front and back torso, and the limbs, we have investigated the effect of user state: stationary or mobile and local environment: anechoic chamber, open office area and hallway upon first and second order statistics for on-body fading channels. Three candidate models were considered: Nakagami, Rice and lognormal. Using maximum likelihood estimation and the Akaike information criterion it was established that the Nakagami-m distribution best described small-scale fading for the majority of on-body channels over all the measurement scenarios. When the user was stationary, Nakagami-m parameters were found to be much greater than 1, irrespective of local surroundings. For mobile channels, Nakagami-m parameters significantly decreased, with channels in the open office area and hallway experiencing the worst fading conditions.

Pattern Switching Compact Patch Antenna for On-body and Off-body Communications at 2.45 GHz

The ability to switch between propagating modes is important for body-centric applications such as medical body area networks where a single node may need to be able to optimise communications for either on-body sensor links or off-body links to the wider network. Therefore, we present a compact 2.45 GHz active mode-switching wearable antenna for both on-body and off-body wireless communications. The single-layer patch antenna was pattern-switched using shorting pins and had an impedance bandwidth of 253 MHz and 217 MHz for the on-body and off-body radiating modes, respectively. An efficiency of 57 % and 56.8 % was obtained for on-body and off-body mode respectively when placed in close proximity to a phantom that represents a muscle issue at 2.45 GHz.

Small angle neutron scattering from 1-alkyl-3-methylimidazolium hexafluorophosphate ionic liquids ([C(n)mim][PF6], n=4, 6, and 8)

The presence of local anisotropy in the bulk, isotropic, and ionic liquid phases-leading to local mesoscopic inhomogeneity-with nanoscale segregation and expanding nonpolar domains on increasing the length of the cation alkyl-substituents has been proposed on the basis of molecular dynamics (MD) simulations. However, there has been little conclusive experimental evidence for the existence of intermediate mesoscopic structure between the first/second shell correlations shown by neutron scattering on short chain length based materials and the mesophase structure of the long chain length ionic liquid crystals. Herein, small angle neutron scattering measurements have been performed on selectively H/D-isotopically substituted 1-alkyl-3-methylimidazolium hexafluorophosphate ionic liquids with butyl, hexyl, and octyl substituents. The data show the unambiguous existence of a diffraction peak in the low-Q region for all three liquids which moves to longer distances (lower Q), sharpens, and increases in intensity with increasing length of the alkyl substituent. It is notable, however, that this peak occurs at lower values of Q (longer length scale) than predicted in any of the previously published MD simulations of ionic liquids, and that the magnitude of the scattering from this peak is comparable with that from the remainder of the amorphous ionic liquid. This strongly suggests that the peak arises from the second coordination shells of the ions along the vector of alkyl-chain substituents as a consequence of increasing the anisotropy of the cation, and that there is little or no long-range correlated nanostructure in these ionic liquids.

Laser-driven quasimonoenergetic proton burst from water spray target

A narrow band proton bursts at energies of 1.6 +/- 0.08 MeV were observed when a water spray consisting of empty set(150 nm)-diameter droplets was irradiated by an ultrashort laser pulse of about 45 fs duration and at an intensity of 5 X 10(19) W/cm(2). The results are explained by a Coulomb explosion of sub-laser-wavelength droplets composed of two ion species. The laser prepulse plays an important role. By pre-evaporation of the droplets, its diameter is reduced so that the main pulse can interact with a smaller droplet, and this remaining bulk can be ionized to high states. In the case of water, the mixture of quite differently charged ions establishes an

Temporal characterization and in vitro comparison of cell survival following the delivery of 3D-conformal, intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT)

A phantom was designed and implemented for the delivery of treatment plans to cells in vitro. Single beam, 3D-conformal radiotherapy (3D-CRT) plans, inverse planned five-field intensity-modulated radiation therapy (IMRT), nine-field IMRT, single-arc volumetric modulated arc therapy (VMAT) and dual-arc VMAT plans were created on a CT scan of the phantom to deliver 3 Gy to the cell layer and verified using a Farmer chamber, 2D ionization chamber array and gafchromic film. Each plan was delivered to a 2D ionization chamber array to assess the temporal characteristics of the plan including delivery time and 'cell's eye view' for the central ionization chamber. The effective fraction time, defined as the percentage of the fraction time where any dose is delivered to each point examined, was also assessed across 120 ionization chambers. Each plan was delivered to human prostate cancer DU-145 cells and normal primary AGO-1522b fibroblast cells. Uniform beams were delivered to each cell line with the delivery time varying from 0.5 to 20.54 min. Effective fraction time was found to increase with a decreasing number of beams or arcs. For a uniform beam delivery, AGO-1552b cells exhibited a statistically significant trend towards increased survival with increased delivery time. This trend was not repeated when the different modulated clinical delivery methods were used. Less sensitive DU-145 cells did not exhibit a significant trend towards increased survival with increased delivery time for either the uniform or clinical deliveries. These results confirm that dose rate effects are most prevalent in more radiosensitive cells. Cell survival data generated from uniform beam deliveries over a range of dose rates and delivery times may not always be accurate in predicting response to more complex delivery techniques, such as IMRT and VMAT.

A search for line intensity enhancements in the far-UV spectra of active late-type stars arising from opacity

Context. Radiative transfer calculations have predicted intensity enhancements for optically thick emission lines, as opposed to the normal intensity reductions, for astrophysical plasmas under certain conditions. In particular, the results are predicted to be dependent both on the geometry of the emitting plasma and the orientation of the observer. Hence in principle the detection of intensity enhancement may provide a way of determining the geometry of an unresolved astronomical source.
Aims. To investigate such enhancements we have analysed a sample of active late-type stars observed in the far ultraviolet spectral region.
Methods. Emission lines of O vi in the FUSE satellite spectra of ϵ Eri, II Peg and Prox Cen were searched for intensity enhancements due to opacity.
Results. We have found strong evidence for line intensity enhancements due to opacity during active or flare-like activity for all three stars. The O vi 1032/1038 line intensity ratios, predicted to have a value of 2.0 in the optically thin case, are found to be up to ~30% larger during several orbital phases.
Conclusions. Our measurements, combined with radiative transfer models, allow us to constrain both the geometry of the O vi emitting regions in our stellar sources and the orientation of the observer. A spherical emitting plasma can be ruled out, as this would lead to no intensity enhancement. In addition, the theory tells us that the line-of-sight to the plasma must be close to perpendicular to its surface, as observations at small angles to the surface lead to either no intensity enhancement or the usual line intensity decrease over the optically thin value. For the future, we outline a laboratory experiment, that could be undertaken with current facilities, which would provide an unequivocal test of predictions of line intensity enhancement due to opacity, in particular the dependence on plasma geometry.

Configuration-interaction effects in and intensity dependence of F- multiphoton detachment

Two- and three-photon detachment rates have been obtained for F- using several expansions in the R-matrix Floquet approach. These rates are compared with other theoretical and experimental results. The use of Hartree-Fock wavefunctions for the ground state of F with addition of continuum electrons does not lead to agreement with experiment for two- and three-photon detachment. By adding correlation terms, agreement with experiment and other theoretical results is improved considerably, demonstrating the importance of electron correlation effects. However, convergence with respect to the wavefunction expansion cannot be established, we also study the intensity dependence of multiphoton detachment rates for F- at the Nd-YAG frequency. Due to the ponderomotive shift the three-photon detachment channel closes at an intensity of 8.5 x 10(11) W cm(-2) and the influence of this channel closure on the multiphoton detachment peaks is illustrated by determining the heights of the excess-photon peaks obtained using a Gaussian laser pulse.

In-vitro investigation of out-of-field cell survival following the delivery of conformal, intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans

The aim of this work is to determine the out-of-field survival of cells irradiated with either the primary field or scattered radiation in the presence and absence of intercellular communication following delivery of conformal, IMRT and VMAT treatment plans. Single beam, conformal, IMRT and VMAT plans were created to deliver 3 Gy to half the area of a T80 flask containing either DU-145 or AGO-1522 cells allowing intercellular communication between the in-and out-of-field cell populations. The same plans were delivered to a similar custom made phantom used to hold two T25 culture flasks, one flask in-field and one out-of-field to allow comparison of cell survival responses when intercellular communication is physically inhibited. Plans were created for the delivery of 8 Gy to the more radio-resistant DU-145 cells only in the presence and absence of intercellular communication. Cell survival was determined by clonogenic assay. In both cell lines, the out-of-field survival was not statistically different between delivery techniques for either cell line or dose. There was however, a statistically significant difference between survival out-of-field when intercellular communication was intact (single T80 culture flask) or inhibited (multiple T25 culture flasks) to in-field for all plans. No statistically significant difference was observed in-field with or without cellular communication to out-of-field for all plans. These data demonstrate out-of-field effects as important determinants of cell survival following exposure to modulated irradiation fields when cellular communication between differentially irradiated cell populations is present. This data is further evidence that refinement of existing radiobiological models to include indirect cell killing effects is required.

The developmental character of cardiac autonomic responses to an acute noxious event in 4- and 8-month-old healthy infants

Heart rate (HR) has been widely studied as a measure of an individual's response to painful stimuli. It remains unclear whether changes in mean HR or the variability of HR are specifically related to the noxious stimulus (i.e. pain). Neither is it well understood how such changes reflect underlying neurologic control mechanisms that produce these responses, or how these mechanisms change during the first year of life. To study the changes in cardiac autonomic modulation that occur with acute pain and with age during early infancy, the relationship between respiratory activity and short-term variations of HR (i.e. respiratory sinus arrhythmia) was quantified in a longitudinal study of term born healthy infants who underwent a finger lance blood collection at 4 months of age (n = 24) and again at 8 months of age (n = 20). Quantitative respiratory activity and HR were obtained during baseline, lance, and recovery periods. Time and frequency domain analyses from 2.2-min epochs of data yielded mean values, spectral measures of low (0.04-0.15 Hz) and high (0.15-0.80 Hz) frequency power (LF and HF), and the LF/HF ratio. To determine sympathetic and parasympathetic cardiac activity, the transfer relation between respiration and HR was used. At both 4 and 8 months, mean HR increased significantly with the noxious event (p > 0.01). There were age-related differences in the pattern of LF, HF, and LF/HF ratio changes. Although these parameters all decreased (p > 0.01) at 4 months, LF and LF/HF increased at 8 months and at 8 months HF remained stable in response to the noxious stimulus. Transfer gain changes with the lance demonstrated a change from predominant vagal baseline to a sympathetic condition at both ages. The primary finding of this study is that a response to an acute noxious stimulus appears to produce an increase in respiratory-related sympathetic HR control and a significant decrease in respiratory-related parasympathetic control at both 4 and 8 months. Furthermore, with increasing age, the sympathetic and parasympathetic changes appear to be less intense, but more sustained.

Children's judgements about pain at age 8-10 years:do extremely low birthweight (<or = 1000 g) children differ from full birthweight peers?

Children's judgements about pain at age 8-10 years were examined comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: extremely low birthweight (ELBW) <or = 1000 g (N = 47) and full birthweight (FBW) > or = 2500 g (N = 37). The 24 pictures that comprise the Pediatric Pain Inventory, depicting events in four settings: medical, recreational, daily living, and psychosocial, were used as the pain stimuli. The subjects rated pain intensity using the Color Analog Scale and pain affect using the Facial Affective Scale. Child IQ and maternal education were statistically adjusted in group comparisons. Pain intensity and pain affect related to activities of daily living and recreation were significantly higher than psychosocial and medically related pain on both scales in both groups of children. Although the two groups of children did not differ overall in their perceptions of pain intensity or affect, the ELBW children rated medical pain intensity significantly higher than psychosocial pain, unlike the FBW group. Also, duration of neonatal intensive care unit stay for the ELBW children was related to increased pain affect ratings in recreational and daily living settings. Despite altered response to pain in the early years reported by parents, on the whole at 8-10 years of age ELBW children judged pain in pictures similarly to their term peers. However, differences were evident, which suggests that studies are needed of biobehavioural reactivity to pain beyond infancy, as well as research into beliefs, attitudes, and perceptions about pain during the course of childhood in formerly ELBW children.