Prevention and treatment of acute radiation-induced skin reactions : a systematic review and meta-analysis of randomized controlled trials

Background Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by swelling,redness, pigmentation, fibrosis, and ulceration, pain, warmth, burning, and itching of the skin. The aim of this systematic review was to assess the effects of interventions which aim to prevent or manage RISR in people with cancer. Methods We searched the following databases up to November 2012: Cochrane Skin Group Specialised Register, CENTRAL (2012, Issue 11), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), CINAHL (from 1981) and LILACS (from 1982). Randomized controlled trials evaluating interventions for preventing or managing RISR in cancer patients were included. The primary outcomes were development of RISR, and levels of RISR and symptom severity. Secondary outcomes were time taken to develop erythema or dry desquamation; quality of life; time taken to heal, a number of skin reaction and symptom severity measures; cost, participant satisfaction; ease of use and adverse effects. Where appropriate, we pooled results of randomized controlled trials using mean differences (MD) or odd ratios (OR) with 95% confidence intervals (CI). Results Forty-seven studies were included in this review. These evaluated six types of interventions (oral systemic medications; skin care practices; steroidal topical therapies; non-steroidal topical therapies; dressings and other). Findings from two meta-analyses demonstrated significant benefits of oral Wobe-Mugos E for preventing RISR (OR 0.13 (95% CI 0.05 to 0.38)) and limiting the maximal level of RISR (MD −0.92 (95% CI −1.36 to −0.48)). Another meta-analysis reported that wearing deodorant does not influence the development of RISR (OR 0.80 (95% CI 0.47 to 1.37)). Conclusions Despite the high number of trials in this area, there is limited good, comparative research that provides definitive results suggesting the effectiveness of any single intervention for reducing RISR. More research is required to demonstrate the usefulness of a wide range of products that are being used for reducing RISR. Future efforts for reducing RISR severity should focus on promising interventions, such as Wobe-Mugos E and oral zinc.

Physiological tolerance times while wearing explosive ordnance disposal protective clothing in simulated environmental extremes

Explosive ordnance disposal (EOD) technicians are required to wear protective clothing to protect themselves from the threat of overpressure, fragmentation, impact and heat. The engineering requirements to minimise these threats results in an extremely heavy and cumbersome clothing ensemble that increases the internal heat generation of the wearer, while the clothing’s thermal properties reduce heat dissipation. This study aimed to evaluate the heat strain encountered wearing EOD protective clothing in simulated environmental extremes across a range of differing work intensities. Eight healthy males [age 25±6 years (mean ± sd), height 180±7 cm, body mass 79±9 kg, V˙O2max 57±6 ml.kg−1.min−1] undertook nine trials while wearing an EOD9 suit (weighing 33.4 kg). The trials involved walking on a treadmill at 2.5, 4 and 5.5 km⋅h−1 at each of the following environmental conditions, 21, 30 and 37°C wet bulb globe temperature (WBGT) in a randomised controlled crossover design. The trials were ceased if the participants’ core temperature reached 39°C, if heart rate exceeded 90% of maximum, if walking time reached 60 minutes or due to fatigue/nausea. Tolerance times ranged from 10–60 minutes and were significantly reduced in the higher walking speeds and environmental conditions. In a total of 15 trials (21%) participants completed 60 minutes of walking; however, this was predominantly at the slower walking speeds in the 21°C WBGT environment. Of the remaining 57 trials, 50 were ceased, due to attainment of 90% maximal heart rate. These near maximal heart rates resulted in moderate-high levels of physiological strain in all trials, despite core temperature only reaching 39°C in one of the 72 trials.

Visual analog scale and pressure pain threshold for delayed onset muscle soreness assessment

Objectives: To investigate the relationship between two assessments to quantify delayed onset muscle soreness [DOMS]: visual analog scale [VAS] and pressure pain threshold [PPT]. Methods: Thirty-one healthy young men [25.8 ± 5.5 years] performed 10 sets of six maximal eccentric contractions of the elbow flexors with their non-dominant arm. Before and one to four days after the exercise, muscle pain perceived upon palpation of the biceps brachii at three sites [5, 9 and 13 cm above the elbow crease] was assessed by VAS with a 100 mm line [0 = no pain, 100 = extremely painful], and PPT of the same sites was determined by an algometer. Changes in VAS and PPT over time were compared amongst three sites by a two-way repeated measures analysis of variance, and the relationship between VAS and PPT was analyzed using a Pearson product-moment correlation. Results: The VAS increased one to four days after exercise and peaked two days post-exercise, while the PPT decreased most one day post-exercise and remained below baseline for four days following exercise [p < 0.05]. No significant difference among the three sites was found for VAS [p = 0.62] or PPT [p = 0.45]. The magnitude of change in VAS did not significantly correlate with that of PPT [r = −0.20, p = 0.28]. Conclusion: These results suggest that the level of muscle pain is not region-specific, at least among the three sites investigated in the study, and VAS and PPT provide different information about DOMS, indicating that VAS and PPT represent different aspects of pain.

A practical and theoretical definition of very small field size for radiotherapy output factor measurements

Purpose This work introduces the concept of very small field size. Output factor (OPF) measurements at these field sizes require extremely careful experimental methodology including the measurement of dosimetric field size at the same time as each OPF measurement. Two quantifiable scientific definitions of the threshold of very small field size are presented. Methods A practical definition was established by quantifying the effect that a 1 mm error in field size or detector position had on OPFs, and setting acceptable uncertainties on OPF at 1%. Alternatively, for a theoretical definition of very small field size, the OPFs were separated into additional factors to investigate the specific effects of lateral electronic disequilibrium, photon scatter in the phantom and source occlusion. The dominant effect was established and formed the basis of a theoretical definition of very small fields. Each factor was obtained using Monte Carlo simulations of a Varian iX linear accelerator for various square field sizes of side length from 4 mm to 100 mm, using a nominal photon energy of 6 MV. Results According to the practical definition established in this project, field sizes < 15 mm were considered to be very small for 6 MV beams for maximal field size uncertainties of 1 mm. If the acceptable uncertainty in the OPF was increased from 1.0 % to 2.0 %, or field size uncertainties are 0.5 mm, field sizes < 12 mm were considered to be very small. Lateral electronic disequilibrium in the phantom was the dominant cause of change in OPF at very small field sizes. Thus the theoretical definition of very small field size coincided to the field size at which lateral electronic disequilibrium clearly caused a greater change in OPF than any other effects. This was found to occur at field sizes < 12 mm. Source occlusion also caused a large change in OPF for field sizes < 8 mm. Based on the results of this study, field sizes < 12 mm were considered to be theoretically very small for 6 MV beams. Conclusions Extremely careful experimental methodology including the measurement of dosimetric field size at the same time as output factor measurement for each field size setting and also very precise detector alignment is required at field sizes at least < 12 mm and more conservatively < 15 mm for 6 MV beams. These recommendations should be applied in addition to all the usual considerations for small field dosimetry, including careful detector selection.

Using the quantum probability ranking principle to rank interdependent documents

A known limitation of the Probability Ranking Principle (PRP) is that it does not cater for dependence between documents. Recently, the Quantum Probability Ranking Principle (QPRP) has been proposed, which implicitly captures dependencies between documents through “quantum interference”. This paper explores whether this new ranking principle leads to improved performance for subtopic retrieval, where novelty and diversity is required. In a thorough empirical investigation, models based on the PRP, as well as other recently proposed ranking strategies for subtopic retrieval (i.e. Maximal Marginal Relevance (MMR) and Portfolio Theory(PT)), are compared against the QPRP. On the given task, it is shown that the QPRP outperforms these other ranking strategies. And unlike MMR and PT, one of the main advantages of the QPRP is that no parameter estimation/tuning is required; making the QPRP both simple and effective. This research demonstrates that the application of quantum theory to problems within information retrieval can lead to significant improvements.

Revisiting sub-topic retrieval in the ImageCLEF 2009 photo retrieval task

Ranking documents according to the Probability Ranking Principle has been theoretically shown to guarantee optimal retrieval effectiveness in tasks such as ad hoc document retrieval. This ranking strategy assumes independence among document relevance assessments. This assumption, however, often does not hold, for example in the scenarios where redundancy in retrieved documents is of major concern, as it is the case in the sub–topic retrieval task. In this chapter, we propose a new ranking strategy for sub–topic retrieval that builds upon the interdependent document relevance and topic–oriented models. With respect to the topic– oriented model, we investigate both static and dynamic clustering techniques, aiming to group topically similar documents. Evidence from clusters is then combined with information about document dependencies to form a new document ranking. We compare and contrast the proposed method against state–of–the–art approaches, such as Maximal Marginal Relevance, Portfolio Theory for Information Retrieval, and standard cluster–based diversification strategies. The empirical investigation is performed on the ImageCLEF 2009 Photo Retrieval collection, where images are assessed with respect to sub–topics of a more general query topic. The experimental results show that our approaches outperform the state–of–the–art strategies with respect to a number of diversity measures.

Document ranking with quantum probabilities

In this thesis we investigate the use of quantum probability theory for ranking documents. Quantum probability theory is used to estimate the probability of relevance of a document given a user's query. We posit that quantum probability theory can lead to a better estimation of the probability of a document being relevant to a user's query than the common approach, i. e. the Probability Ranking Principle (PRP), which is based upon Kolmogorovian probability theory. Following our hypothesis, we formulate an analogy between the document retrieval scenario and a physical scenario, that of the double slit experiment. Through the analogy, we propose a novel ranking approach, the quantum probability ranking principle (qPRP). Key to our proposal is the presence of quantum interference. Mathematically, this is the statistical deviation between empirical observations and expected values predicted by the Kolmogorovian rule of additivity of probabilities of disjoint events in configurations such that of the double slit experiment. We propose an interpretation of quantum interference in the document ranking scenario, and examine how quantum interference can be effectively estimated for document retrieval. To validate our proposal and to gain more insights about approaches for document ranking, we (1) analyse PRP, qPRP and other ranking approaches, exposing the assumptions underlying their ranking criteria and formulating the conditions for the optimality of the two ranking principles, (2) empirically compare three ranking principles (i. e. PRP, interactive PRP, and qPRP) and two state-of-the-art ranking strategies in two retrieval scenarios, those of ad-hoc retrieval and diversity retrieval, (3) analytically contrast the ranking criteria of the examined approaches, exposing similarities and differences, (4) study the ranking behaviours of approaches alternative to PRP in terms of the kinematics they impose on relevant documents, i. e. by considering the extent and direction of the movements of relevant documents across the ranking recorded when comparing PRP against its alternatives. Our findings show that the effectiveness of the examined ranking approaches strongly depends upon the evaluation context. In the traditional evaluation context of ad-hoc retrieval, PRP is empirically shown to be better or comparable to alternative ranking approaches. However, when we turn to examine evaluation contexts that account for interdependent document relevance (i. e. when the relevance of a document is assessed also with respect to other retrieved documents, as it is the case in the diversity retrieval scenario) then the use of quantum probability theory and thus of qPRP is shown to improve retrieval and ranking effectiveness over the traditional PRP and alternative ranking strategies, such as Maximal Marginal Relevance, Portfolio theory, and Interactive PRP. This work represents a significant step forward regarding the use of quantum theory in information retrieval. It demonstrates in fact that the application of quantum theory to problems within information retrieval can lead to improvements both in modelling power and retrieval effectiveness, allowing the constructions of models that capture the complexity of information retrieval situations. Furthermore, the thesis opens up a number of lines for future research. These include: (1) investigating estimations and approximations of quantum interference in qPRP; (2) exploiting complex numbers for the representation of documents and queries, and; (3) applying the concepts underlying qPRP to tasks other than document ranking.

Combining word semantics within complex Hilbert space for information retrieval

Complex numbers are a fundamental aspect of the mathematical formalism of quantum physics. Quantum-like models developed outside physics often overlooked the role of complex numbers. Specifically, previous models in Information Retrieval (IR) ignored complex numbers. We argue that to advance the use of quantum models of IR, one has to lift the constraint of real-valued representations of the information space, and package more information within the representation by means of complex numbers. As a first attempt, we propose a complex-valued representation for IR, which explicitly uses complex valued Hilbert spaces, and thus where terms, documents and queries are represented as complex-valued vectors. The proposal consists of integrating distributional semantics evidence within the real component of a term vector; whereas, ontological information is encoded in the imaginary component. Our proposal has the merit of lifting the role of complex numbers from a computational byproduct of the model to the very mathematical texture that unifies different levels of semantic information. An empirical instantiation of our proposal is tested in the TREC Medical Record task of retrieving cohorts for clinical studies.

Graph coloring applied to secure computation in non-Abelian groups

We study the natural problem of secure n-party computation (in the computationally unbounded attack model) of circuits over an arbitrary finite non-Abelian group (G,⋅), which we call G-circuits. Besides its intrinsic interest, this problem is also motivating by a completeness result of Barrington, stating that such protocols can be applied for general secure computation of arbitrary functions. For flexibility, we are interested in protocols which only require black-box access to the group G (i.e. the only computations performed by players in the protocol are a group operation, a group inverse, or sampling a uniformly random group element). Our investigations focus on the passive adversarial model, where up to t of the n participating parties are corrupted.

In-vehicle extremity injuries from improvised explosive devices : current and future foci

The conflicts in Iraq and Afghanistan have been epitomized by the insurgents’ use of the improvised explosive device against vehicle-borne security forces. These weapons, capable of causing multiple severely injured casualties in a single incident, pose the most prevalent single threat to Coalition troops operating in the region. Improvements in personal protection and medical care have resulted in increasing numbers of casualties surviving with complex lower limb injuries, often leading to long-term disability. Thus, there exists an urgent requirement to investigate and mitigate against the mechanism of extremity injury caused by these devices. This will necessitate an ontological approach, linking molecular, cellular and tissue interaction to physiological dysfunction. This can only be achieved via a collaborative approach between clinicians, natural scientists and engineers, combining physical and numerical modelling tools with clinical data from the battlefield. In this article, we compile existing knowledge on the effects of explosions on skeletal injury, review and critique relevant experimental and computational research related to lower limb injury and damage and propose research foci required to drive the development of future mitigation technologies.

Nanostructured metal hydrides for hydrogen storage studied by in situ synchrotron and neutron diffraction

This work was focused on studies of the metal hydride materials having a potential in building hydrogen storage systems with high gravimetric and volumetric efficiencies of H storage and formed / decomposed with high rates of hydrogen exchange. In situ diffraction studies of the metal-hydrogen systems were explored as a valuable tool in probing both the mechanism of the phase-structural transformations and their kinetics. Two complementary techniques, namely Neutron Powder Diffraction (NPD) and Synchrotron X-ray diffraction (SR XRD) were utilised. High pressure in situ NPD studies were performed at D2 pressures reaching 1000 bar at the D1B diffractometer accommodated at Institute Laue Langevin, Grenoble. The data of the time resolved in situ SR XRD were collected at the Swiss Norwegian Beam Lines, ESRF, Grenoble in the pressure range up to 50 bar H2 at temperatures 20-400°C. The systems studied by NPD at high pressures included deuterated Al-modified Laves-type C15 ZrFe2-xAlx intermetallics with x = 0.02; 0.04 and 0.20 and the CeNi5-D2 system. D content, hysteresis of H uptake and release, unit cell expansion and stability of the hydrides systematically change with Al content. Deuteration exhibited a very fast kinetics; it resulted in increase of the unit cells volumes reaching 23.5 % for ZrFe1.98Al0.02D2.9(1) and associated with exclusive occupancy of the Zr2(Fe,Al)2 tetrahedra. For CeNi5 deuteration yielded a hexahydride CeNi5D6.2 (20°C, 776 bar D2) and was accompanied by a nearly isotropic volume expansion reaching 30.1% (∆a/a=10.0%; ∆c/c=7.5%). Deuterium atoms fill three different interstitial sites including Ce2Ni2, Ce2Ni3 and Ni4. Significant hysteresis was observed on the first absorption-desorption cycle. This hysteresis decreased on the absorption-desorption cycling. A different approach to the development of H storage systems is based on the hydrides of light elements, first of all the Mg-based ones. These systems were studied by SR XRD. Reactive ball milling in hydrogen (HRBM) allowed synthesis of the nanostructured Mg-based hydrides. The experimental parameters (PH2, T, energy of milling, ball / sample ratio and balls size), significantly influence rate of hydrogenation. The studies confirmed (a) a completeness of hydrogenation of Mg into MgH2; (b) indicated a partial transformation of the originally formed -MgH2 into a metastable -MgH2 (a ratio / was 3/1); (c) yielded the crystallite size for the main hydrogenation product, -MgH2, as close to 10 nm. Influence of the additives to Mg on the structure and hydrogen absorption/desorption properties and cycle behaviour of the composites was established and will be discussed in the paper.

Methanesulfonic acid-catalyzed conversion of glucose and xylose mixtures to levulinic acid and furfural

Methanesulfonic acid (MSA) was compared with sulfuric acid for the conversion of glucose and xylose mixtures to produce levulinic acid and furfural. The interactions of glucose and xylose, the predominant sugars found in biomass, were found to influence product yields with furfural degradation reactions enhanced under higher reactant loadings. Fast heating rates allowed maximal yields (>60 mol%) of levulinic acid and furfural to be achieved under short reaction times. Under the range of conditions examined, sulfuric acid produced a slight increase in levulinic acid yield by 6% (P = 0.02), although there was no significant difference (P = 0.11) between MSA and sulfuric acid in levulinic acid formed from glucose alone. The amount and type of the solid residue is similar between MSA and sulfuric acid. As such, MSA is a suitable alternative because its use minimizes corrosion and disposal issues associated with mineral acid catalysts. The heating value of the residue was 22 MJ/kg implying that it is a suitable source of fuel. On the basis of these results, a two-stage processing strategy is proposed to target high levulinic acid and furfural yields, and other chemical products (e.g., lactic acid, xylitol, acetic acid and formic acid). This will result in full utilization of bagasse components.

Management of multiple heterogeneous UAVs using capability and autonomy visualisation: theory, experiment and result

The interest in utilising multiple heterogeneous Unmanned Aerial Vehicles (UAVs) in close proximity is growing rapidly. As such, many challenges are presented in the effective coordination and management of these UAVs; converting the current n-to-1 paradigm (n operators operating a single UAV) to the 1-to-n paradigm (one operator managing n UAVs). This paper introduces an Information Abstraction methodology used to produce the functional capability framework initially proposed by Chen et al. and its Level Of Detail (LOD) indexing scale. This framework was validated through comparing the operator workload and Situation Awareness (SA) of three experiment scenarios involving multiple autonomously heterogeneous UAVs. The first scenario was set in a high LOD configuration with highly abstracted UAV functional information; the second scenario was set in a mixed LOD configuration; and the final scenario was set in a low LOD configuration with maximal UAV functional information. Results show that there is a significant statistical decrease in operator workload when a UAV’s functional information is displayed at its physical form (low LOD - maximal information) when comparing to the mixed LOD configuration.

Ecological risk analysis of transgenic plants

Public concern about the safety of many forms of industrial technology are known to be linked to a range of factors including a perceived lack of confidence in regulatory decision making.1 The use of transgenic plants in agriculture may be seen as an issue that could generate similar concern. Criticism has been made about the completeness of knowledge on the potential for aberrant behaviour of genetically manipulated organisms (GMO's) in release environments, and the adequacy of existing pre­‐release screening and assessment methodologies (Goldberg & Tjaden, 1990). Such comments are important because any perceived shortcomings in the pre-release assessment of GMO safety may lead to decreased public support of the technology -­‐and the industry itself...

Effects of short-duration and long-duration exercise on lipoprotein(a)

Purpose Most studies that use either a single exercise session, exercise training, or a cross-sectional design have failed to find a relationship between exercise and plasma lipoprotein(a) [Lp(a)] concentrations. However, a few studies investigating the effects of longer and/or more strenuous exercise have shown elevated Lp(a) concentrations, possibly as an acute-phase reactant to muscle damage. Based on the assumption that greater muscle damage would occur with exercise of longer duration, the purpose of the present study was to determine whether exercise of longer duration would increase Lp(a) concentration and creatine kinase. (CK) activity more than exercise of shorter duration. Methods Ten endurance-trained men (mean +/- SD: age, 27 +/- 6 yr; maximal oxygen consumption [(V)over dotO(2max)], 57 +/- 7 mL(.)kg(-1) min(-1)) completed two separate exercise sessions at 70% (V)over dotO(2max). One session required 900 kcal of energy expenditure (60 +/- 6 min), and the other required 1500 kcal (112 +/- 12 min). Fasted blood samples were taken immediately before (0-pre), immediately after (0-post), 1 d after (1-post), and 2 d after (2-post) each exercise session. Results CK activity increased after both exercise sessions (mean +/- SE; 800 kcal: 0-pre 55 +/- 11, 1-post 168 +/- 64 U(.)L(-1.)min(-1); 1500 kcal: 0-pre 51 +/- 5, 1-post 187 +/- 30, 2-post 123 +/- 19 U(.)L(-1.)min(-1); P < 0.05). However, median Lp(a) concentrations were not altered by either exercise session (800 kcal: 0-pre 5.0 mg(.)dL(-1), 0-post 3.2 mg(.)dL(-1), 1-post 4.0 mg(.)dL(-1), 2-post 3.4 mg(.)dL(-1); 1500 kcal: 0-pre 5.8 mg(.)dL(-1), 0-post 4.3 mg(.)dL(-1), 1-post 3.2 mg(.)dL(-1), 2-post 5.3 mg(.)dL(-1)). In addition, no relationship existed between exercise-induced changes in CK activity and Lp(a) concentration (800 kcal: r = -0.26; 1500 kcal: r = -0.02). Conclusion These results suggest that plasma Lp(a) concentration will not increase in response to minor exercise-induced muscle damage in endurance-trained runners.