Assessment of patient setup errors in IGRT in combination with a six degrees of freedom couch

PURPOSE The range of patient setup errors in six dimensions detected in clinical routine for cranial as well as for extracranial treatments, were analyzed while performing linear accelerator based stereotactic treatments with frameless patient setup systems. Additionally, the need for re-verification of the patient setup for situations where couch rotations are involved was analyzed for patients treated in the cranial region. METHODS AND MATERIALS A total of 2185 initial (i.e. after pre-positioning the patient with the infrared system but before image guidance) patient setup errors (1705 in the cranial and 480 in the extracranial region) obtained by using ExacTrac (BrainLAB AG, Feldkirchen, Germany) were analyzed. Additionally, the patient setup errors as a function of the couch rotation angle were obtained by analyzing 242 setup errors in the cranial region. Before the couch was rotated, the patient setup error was corrected at couch rotation angle 0° with the aid of image guidance and the six degrees of freedom (6DoF) couch. For both situations attainment rates for two different tolerances (tolerance A: ± 0.5mm, ± 0.5°; tolerance B: ± 1.0 mm, ± 1.0°) were calculated. RESULTS The mean (± one standard deviation) initial patient setup errors for the cranial cases were -0.24 ± 1.21°, -0.23 ± 0.91° and -0.03 ± 1.07° for the pitch, roll and couch rotation axes and 0.10 ± 1.17 mm, 0.10 ± 1.62 mm and 0.11 ± 1.29 mm for the lateral, longitudinal and vertical axes, respectively. Attainment rate (all six axes simultaneously) for tolerance A was 0.6% and 13.1% for tolerance B, respectively. For the extracranial cases the corresponding values were -0.21 ± 0.95°, -0.05 ± 1.08° and -0.14 ± 1.02° for the pitch, roll and couch rotation axes and 0.15 ± 1.77 mm, 0.62 ± 1.94 mm and -0.40 ± 2.15 mm for the lateral, longitudinal and vertical axes. Attainment rate (all six axes simultaneously) for tolerance A was 0.0% and 3.1% for tolerance B, respectively. After initial setup correction and rotation of the couch to treatment position a re-correction has to be performed in 77.4% of all cases to fulfill tolerance A and in 15.6% of all cases to fulfill tolerance B. CONCLUSION The analysis of the data shows that all six axes of a 6DoF couch are used extensively for patient setup in clinical routine. In order to fulfill high patient setup accuracies (e.g. for stereotactic treatments), a 6DoF couch is recommended. Moreover, re-verification of the patient setup after rotating the couch is required in clinical routine.

Fractures in Children and Adolescents

Fractures of the growing bone require fixation techniques, which preclude any injury to the growth plate regions. This requirement is met by Elastic Stable Intramedullary Nails (ESIN) which are positioned between both metaphyseal regions. Pronounced malposition and/or shortening, open fractures and fractures with impending skin perforation are indications for clavicle nailing in adolescents. Retrograde nailing with two elastic nails, inserted from lateral, is the method of choice for stabilization of humerus fractures. In radial neck fractures with severe tilting of the radial head, a retrograde nail may reduce and fix the head. In Monteggia lesions, the ulna fracture is reduced and fixed with an antegrade nail. Forearm fractures with unacceptable axial deviation are reduced and fixed with one antegrade nail in the ulna and a retrograde nail in the radius. Ascending elastic nailing is done for femur shaft and proximal femur fractures. The medial and lateral entry sites are located above the distal physis. End caps are used to prevent shortening in spiral and multiple segment fractures. Fractures of the distal third of the femur are nailed in a descending technique. The entry sites of two nails are located on the lateral cortex below the greater trochanter. Combined tibia and fibula fractures, open fractures and unstable fracture types such as spiral and multifragmental tibia fractures are good indications for ESIN. Descending nailing is the method of choice. The nail entry points are medially and laterally distal to the apophysis of the proximal tibia. Thorough knowledge of each fracture type, fracture location and age specific healing pattern is necessary for safe and effective treatment of pediatric fractures

Perception of therapeutic Qi, a nonmechanical, nonpsychological factor in acupuncture that originates from the therapist

So far, most research attempts to explain the mechanism of the action of acupuncture have focused mostly on mechanically-triggered active factors and have produced inconclusive findings. In this study, we investigate whether acupuncture might also involve nonmechanical, nonpsychological active factors originating in the therapist. In 30 individuals, an acupuncture needle was inserted in the acupoint PC6 using a special device without touching the needle. A second device was used to fix the needle rigidly in place, excluding any mechanical transmission of movement from the handle to the needle's tip. Each participant was exposed in random order to a control and a stimulation phase. During the stimulation phase, the free needle's end was held by the therapist to allow the transmission of Qi; during the control phase, it was left untouched. Participants' subjective sensations during the stimulation phase and the control phase were recorded using a questionnaire. Twenty-two of 28 (79%; p = 0.003) test participants believed that they had received stimulation when it had actually been performed, and 26 (93%; p < 0.001) sensed differences between the two experimental phases. Thus, participants were able to sense the transmission of therapeutic Qi in the absence of mechanical or psychological factors.

Cognitive Cities: An Application for Nairobi. Text Message Participation of Slum Inhabitants to Improve Sanitary Facilities

Population growth is always increasing, and thus the concept of smart and cognitive cities is becoming more important. Developed countries are aware of and working towards needed changes in city management. However, emerging countries require the optimization of their own city management. This chapter illustrates, based on a use case, how a city in an emerging country can quickly progress using the concept of smart and cognitive cities. Nairobi, the capital of Kenya, is chosen for the test case. More than half of the population of Nairobi lives in slums with poor sanitation, and many slum inhabitants often share a single toilet, so the proper functioning and reliable maintenance of toilets are crucial. For this purpose, an approach for processing text messages based on cognitive computing (using soft computing methods) is introduced. Slum inhabitants can inform the responsible center via text messages in cases when toilets are not functioning properly. Through cognitive computer systems, the responsible center can fix the problem in a quick and efficient way by sending repair workers to the area. Focusing on the slum of Kibera, an easy-to-handle approach for slum inhabitants is presented, which can make the city more efficient, sustainable and resilient (i.e., cognitive).

Treatment planning aspects and Monte Carlo methods in proton therapy

Over the last years, the interest in proton radiotherapy is rapidly increasing. Protons provide superior physical properties compared with conventional radiotherapy using photons. These properties result in depth dose curves with a large dose peak at the end of the proton track and the finite proton range allows sparing the distally located healthy tissue. These properties offer an increased flexibility in proton radiotherapy, but also increase the demand in accurate dose estimations. To carry out accurate dose calculations, first an accurate and detailed characterization of the physical proton beam exiting the treatment head is necessary for both currently available delivery techniques: scattered and scanned proton beams. Since Monte Carlo (MC) methods follow the particle track simulating the interactions from first principles, this technique is perfectly suited to accurately model the treatment head. Nevertheless, careful validation of these MC models is necessary. While for the dose estimation pencil beam algorithms provide the advantage of fast computations, they are limited in accuracy. In contrast, MC dose calculation algorithms overcome these limitations and due to recent improvements in efficiency, these algorithms are expected to improve the accuracy of the calculated dose distributions and to be introduced in clinical routine in the near future.

Production Streamlining through Design, Implementation, and Analysis of Lean Manufacturing Methods

Through the correct implementation of lean manufacturing methods, a company can greatly improve their business. Over a period of three months at TTM Technologies, I utilized my knowledge to fix existing problems ans streamline production. In addition, other trouble areas in their production process were discovered and proper lean methods were used to address them. TTM Technologies saw many changed in the right direction over this time period.

Foodborne illness, food inspection policy and restaurants in the U.S.

Objectives. The purpose of this paper is to conduct a literature review of research relating to foodborne illness, food inspection policy, and restaurants in the United States. Aim 1: To convey the public health importance of studying restaurant food inspection policies and suggest that more research is needed in this field, Aim 2: To conduct a systematic literature review of recent literature pertaining to this subject such that future researchers can understand the: (1) Public perception and expectations of restaurant food inspection policies; (2) Arguments in favor of a grade card policy; and, conversely; (3) Reasons why inspection policies may not work. ^ Data/methods. This paper utilizes a systematic review format to review articles relating to food inspections and restaurants in the U.S. Eight articles were reviewed. ^ Results. The resulting data from the literature provides no conclusive answer as to how, when, and in what method inspection policies should be carried out. The authors do, however, put forward varying solutions as to how to fix the problem of foodborne illness outbreaks in restaurants. These solutions include the implementation of grade cards in restaurants and, conversely, a complete overhaul of the inspection policy system.^ Discussion. The literature on foodborne disease, food inspection policy, and restaurants in the U.S. is limited and varied. But, from the research that is available, we can see that two schools of thought exist. The first of these calls for the implementation of a grade card system, while the second proposes a reassessment and possible overhaul of the food inspection policy system. It is still unclear which of these methods would best slow the increase in foodborne disease transmission in the U.S.^ Conclusion. In order to arrive at solutions to the problem of foodborne disease transmission as it relates to restaurants in this country, we may need to look at literature from other countries and, subsequently, begin incremental changes in the way inspection policies are developed and enforced.^

Funciones de la novela sentimental hispanoamericana durante el siglo XIX

Se analizará cómo funcionan los textos sentimentales hispanoamericanos en los lectores según dos modos de concebir la recepción de estas obras: la lectura en un “microambiente" de un lector/a sentimental-individual y la lectura en un “macroambiente" de varios lectores de novelas sentimentales. Así también, se pretende fijar las características fundamentales de la narrativa sentimental hispanoamericana en un conjunto de textos representativos de esta modalidad literaria. A su vez, este análisis intenta ser una “nueva visión" de los textos enriquecida sobre todo con la ayuda valiosa de enfoques desde lo “literario-cultural" (Lander, 2003), lo “discursivo" (Barthes, [1977] 2002) y lo “sociológico" (Giddens [1992] 2004). En esta ocasión sólo nos ocuparemos de la narrativa del siglo XIX y el corpus de obras será el siguiente: Soledad (1847) y Memorias de un botón de rosa (1847, reeditada en 1907) de Bartolomé Mitre; Esther de Miguel Cané (1851); Martín Rivas (1862) de Alberto Blest Gana; Julia (1861) de Luis Benjamín Cisneros; La peregrinación de Bayoán (1861) de José María de Hostos; María (1867) de Jorge Isaacs; Clemencia (1869) de Ignacio Manuel Altamirano y Cumandá (1879) de Juan León Mera.

Physicochemical and photosynthetic characteristics of water samples obtained during a CCGS Amundsen cruise in 2008

During summer 2008, as part of the Circumpolar Flaw Lead system study, we measured phytoplankton photosynthetic parameters to understand regional patterns in primary productivity, including the degree and timescale of photoacclimation and how variability in environmental conditions influences this response. Photosynthesis-irradiance measurements were taken at 15 sites primarily from the depth of the subsurface chlorophyll a (Chl a) maximum (SCM) within the Beaufort Sea flaw lead polynya. The physiological response of phytoplankton to a range of light levels was used to assess maximum rates of carbon (C) fixation (P*m), photosynthetic efficiency (alpha*), photoacclimation (Ek), and photoinhibition (beta*). SCM samples taken along a transect from under ice into open water exhibited a >3-fold increase in alpha* and P*m, showing these parameters can vary substantially over relatively small spatial scales, primarily in response to changes in the ambient light field. Algae were able to maintain relatively high rates of C fixation despite low light at the SCM, particularly in the large (>5 µm) size fraction at open water sites. This may substantially impact biogenic C drawdown if species composition shifts in response to future climate change. Our results suggest that phytoplankton in this region are well acclimated to existing environmental conditions, including sea ice cover, low light, and nutrient pulses. Furthermore, this photoacclimatory response can be rapid and keep pace with a developing SCM, as phytoplankton maintain photosynthetic rates and efficiencies in a narrow ''shade-acclimated'' range.

Biotic and abiotic parameters and cynobacteria abundance during an experimental set-up with varying pCO2 conditions

Heterocystous cyanobacteria of the genus Nodularia form extensive blooms in the Baltic Sea and contribute substantially to the total annual primary production. Moreover, they dispense a large fraction of new nitrogen to the ecosystem when inorganic nitrogen concentration in summer is low. Thus, it is of ecological importance to know how Nodularia will react to future environmental changes, in particular to increasing carbon dioxide (CO2) concentrations and what consequences there might arise for cycling of organic matter in the Baltic Sea. Here, we determined carbon (C) and dinitrogen (N2) fixation rates, growth, elemental stoichiometry of particulate organic matter and nitrogen turnover in batch cultures of the heterocystous cyanobacterium Nodularia spumigena under low (median 315 µatm), mid (median 353 µatm), and high (median 548 µatm) CO2 concentrations. Our results demonstrate an overall stimulating effect of rising pCO2 on C and N2 fixation, as well as on cell growth. An increase in pCO2 during incubation days 0 to 9 resulted in an elevation in growth rate by 84 ± 38% (low vs. high pCO2) and 40 ± 25% (mid vs. high pCO2), as well as in N2 fixation by 93 ± 35% and 38 ± 1%, respectively. C uptake rates showed high standard deviations within treatments and in between sampling days. Nevertheless, C fixation in the high pCO2 treatment was elevated compared to the other two treatments by 97% (high vs. low) and 44% (high vs. mid) at day 0 and day 3, but this effect diminished afterwards. Additionally, elevation in carbon to nitrogen and nitrogen to phosphorus ratios of the particulate biomass formed (POC : POP and PON : POP) was observed at high pCO2. Our findings suggest that rising pCO2 stimulates the growth of heterocystous diazotrophic cyanobacteria, in a similar way as reported for the non-heterocystous diazotroph Trichodesmium. Implications for biogeochemical cycling and food web dynamics, as well as ecological and socio-economical aspects in the Baltic Sea are discussed.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Análisis y comentarios de fuentes para el estudio de la tierra en los partidos de Chascomús, Ranchos y Monte 1779-1850

El objetivo de esta comunicación es revisar las fuentes utilizadas por los historiadores y relacionarlas mediante series completas de datos en un período más amplio de tiempo, con el fin de abarcar todas las alternativas legales para la adquisición de la tierra. Para fijar espacialmente la cuestión y determinar la ubicación de las parcelas se reconstruye el Registro Gráfico de 1830, complementando las deficiencias de información con expedientes de Escribanía Mayor de Gobierno, libros de Mensuras Antiguas y Duplicados de Mensura. Se pondera el grado de exactitud de la información que contiene la fuente, se completan las áreas vacías y, por último, se utiliza el resultado final para producir dos registros gráficos que reflejen la ocupación y propiedad legal de la tierra para 1822 y 1850, con el fin de verificar el grado de subdivisión parcelaria. El espacio trabajado se circunscribe a los actuales partidos de Chascomús, General Paz y Monte al noreste del río Salado

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Tecnología agropecuaria y agronegocios : La lógica subyacente del modelo tecnológico dominante

El artículo analiza las principales características del modelo tecnológico del agronegocio en la Argentina, discute sus principales problemas y propone una reflexión que enmarque la problemática en contextos económicos y políticos más amplios. Esta tecnología es descripta como technological fix y se presentan tres atributos principales: instantaneidad, transitoriedad y recurrencia. La supuesta eficiencia del modelo productivo ocurre a expensas de la dilapidación del capital natural y de los costos que internalizan otros actores sociales, ya sea vía acumulación por desposesión o a través de la socialización y del diferimiento temporal de sus externalidades negativas. Su fortaleza radica en que su poder trasciende largamente la esfera tecnológica. Poner en dudas al actual modelo implica no sólo cuestionar a su cabeza visible (i.e., el agronegocio), sino también objetar a las instituciones (científicas, educativas, legales y administrativas) y a las estructuras políticas que lo sostienen. Finalmente, el artículo discute algunas alternativas y propone desarrollar una agronomía política para Latinoamérica.

Análisis y comentarios de fuentes para el estudio de la tierra en los partidos de Chascomús, Ranchos y Monte 1779-1850

El objetivo de esta comunicación es revisar las fuentes utilizadas por los historiadores y relacionarlas mediante series completas de datos en un período más amplio de tiempo, con el fin de abarcar todas las alternativas legales para la adquisición de la tierra. Para fijar espacialmente la cuestión y determinar la ubicación de las parcelas se reconstruye el Registro Gráfico de 1830, complementando las deficiencias de información con expedientes de Escribanía Mayor de Gobierno, libros de Mensuras Antiguas y Duplicados de Mensura. Se pondera el grado de exactitud de la información que contiene la fuente, se completan las áreas vacías y, por último, se utiliza el resultado final para producir dos registros gráficos que reflejen la ocupación y propiedad legal de la tierra para 1822 y 1850, con el fin de verificar el grado de subdivisión parcelaria. El espacio trabajado se circunscribe a los actuales partidos de Chascomús, General Paz y Monte al noreste del río Salado