Motion Management for Radical Radiotherapy in Non-small Cell Lung Cancer

Intrafraction tumour motion is an issue that is of increased interest in the era of image-guided radiotherapy. It is particularly relevant for non-small cell lung cancer, for which a number of recent developments are in use to aid with motion management in the delivery of radical radiotherapy. The ability to deliver hypofractionated ablative doses, such as in stereotactic radiotherapy, has been aided by improvements in the ability to analyse tumour motion and amend treatment delivery. In addition, accounting for tumour motion can enable dose escalation to occur by reducing the normal tissue being irradiated by virtue of a reduction in target volumes. Motion management for lung tumours incorporates five key components: imaging, breath-hold techniques, abdominal compression, respiratory tracking and respiratory gating. These will be described, together with the relevant benefits and associated complexities. Many studies have described improved dosimetric coverage and reduced normal tissue complication probability rates when using motion management techniques. Despite the widespread uptake of many of these techniques, there is a paucity of literature reporting improved outcome in overall survival and local control for patients whenever motion management techniques are used. This overview will review the extent of lung tumour motion, ways in which motion is detected and summarise the key methods used in motion management.

Detection of cardiac arrest using a simplified frequency analysis of the impedance cardiogram recorded from defibrillator pads

An algorithm based only on the impedance cardiogram (ICG) recorded through two defibrillation pads, using the strongest frequency component and amplitude, incorporated into a defibrillator could determine circulatory arrest and reduce delays in starting cardiopulmonary resuscitation (CPR). Frequency analysis of the ICG signal is carried out by integer filters on a sample by sample basis. They are simpler, lighter and more versatile when compared to the FFT. This alternative approach, although less accurate, is preferred due to the limited processing capacity of devices that could compromise real time usability of the FFT. These two techniques were compared across a data set comprising 13 cases of cardiac arrest and 6 normal controls. The best filters were refined on this training set and an algorithm for the detection of cardiac arrest was trained on a wider data set. The algorithm was finally tested on a validation set. The ICG was recorded in 132 cardiac arrest patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with a sensitivity of 81.1% (77.6-84.3) and specificity of 97.1% (96.7-97.4) for the validation set (95% confidence intervals). Automated defibrillators with integrated ICG analysis have the potential to improve emergency care by lay persons enabling more rapid and appropriate initiation of CPR and when combined with ECG analysis they could improve on the detection of cardiac arrest.

Defining Simulation Intent

Defining Simulation Intent involves capturing high level modelling and idealisation decisions in order to create an efficient and fit-for-purpose analysis. These decisions are recorded as attributes of the decomposed design space.

An approach to defining Simulation Intent is described utilising three known technologies: Cellular Modelling, the subdivision of space into volumes of simulation significance (structures, gas paths, internal and external airflows etc.); Equivalencing, maintaining a consistent and coherent description
of the equivalent representations of the spatial cells in different analysis models; and Virtual Topology, which offers tools for partitioning and de-partitioning the model without disturbing the manufacturing oriented design geometry. The end result is a convenient framework to which high level analysis attributes can be applied, and from which detailed analysis models can be generated
with a high degree of controllability, repeatability and automation. There are multiple novel aspects to the approach, including its reusability, robustness to changes in model topology and the inherent links created between analysis models at different levels of fidelity and physics.

By utilising Simulation Intent, CAD modelling for simulation can be fully exploited and simulation work-flows can be more readily automated, reducing many repetitive manual tasks (e.g. the definition of appropriate coupling between elements of different types and the application of boundary conditions). The approach has been implemented and tested with practical examples, and
significant benefits are demonstrated.

Single vocal cord irradiation:a competitive treatment strategy in early glottic cancer

INTRODUCTION: The treatment of choice for early glottic cancer is still being debated; ultimately it relies on the functional outcome. This paper reports on a novel sparing 4D conformal technique for single vocal cord irradiation (SVCI).

MATERIAL AND METHODS: The records of 164 T1a patients with SCC of the vocal cord, irradiated in the Erasmus MC between 2000 and 2008, were analyzed for local control and overall survival. The quality of life was determined by EORTC H&N35 questionnaires. Also the VHI (voice handicap index), and the TSH (thyroid stimulating hormone) blood levels, were established. On-line image guided SVCI, using cone beam CT or stereotactic radiation therapy (SRT) techniques, were developed.

RESULTS: A LC rate at five-years of 93% and a VHI of 12.7 (0-63) was determined. It appeared feasible to irradiate one vocal cord within 1-2mm accuracy. This way sparing of the contralateral (CL) vocal cord and CL normal tissues, could be achieved.

CONCLUSIONS: Given the accuracy (1-2mm) and small volume disease (CTV limited to one vocal cord), for the use of stereotactic RT techniques SVCI with large fraction sizes is currently being investigated in clinic. It is argued that hypofractionated SVCI can be a competitive alternative to laser surgery.

Retinal microvascular network attenuation in Alzheimer's disease

INTRODUCTION:Cerebral small-vessel disease has been implicated in the development of Alzheimer’sdisease (AD). The retinal microvasculature enables non-invasive visualization andevaluation of the systemic microcirculation. We evaluated retinal microvascular parametersin a case-control study of AD patients and cognitively-normal controls. 

METHODS:Retinal images were computationally analyzed and quantitative retinal parameters (caliber,fractal dimension, tortuosity, and bifurcation) measured. Regression models were used tocompute odds ratios (OR) and confidence intervals (CI) for AD with adjustment forconfounders. 

RESULTS:Retinal images were available in 213 AD participants and 294 cognitively-normal controls.Persons with lower venular fractal dimension (OR per standard deviation [SD] increase, 0.77[CI: 0.62–0.97]) and lower arteriolar tortuosity (OR per SD increase, 0.78 [CI: 0.63–0.97])were more likely to have AD following appropriate adjustment. 
DISCUSSION:Patients with AD have a sparser retinal microvascular network and retinal microvascularvariation may represent similar pathophysiological events within the cerebralmicrovasculature of patients with AD.

Cellular signalling effects in high precision radiotherapy

Radiotherapy is commonly planned on the basis of physical dose received by the tumour and surrounding normal tissue, with margins added to address the possibility of geometric miss. However, recent experimental evidence suggests that intercellular signalling results in a given cell's survival also depending on the dose received by neighbouring cells. A model of radiation-induced cell killing and signalling was used to analyse how this effect depends on dose and margin choices. Effective Uniform Doses were calculated for model tumours in both idealised cases with no delivery uncertainty and more realistic cases incorporating geometric uncertainty. In highly conformal irradiation, a lack of signalling from outside the target leads to reduced target cell killing, equivalent to under-dosing by up to 10% compared to large uniform fields. This effect is significantly reduced when higher doses per fraction are considered, both increasing the level of cell killing and reducing margin sensitivity. These effects may limit the achievable biological precision of techniques such as stereotactic radiotherapy even in the absence of geometric uncertainties, although it is predicted that larger fraction sizes reduce the relative contribution of cell signalling driven effects. These observations may contribute to understanding the efficacy of hypo-fractionated radiotherapy.

Selecting superluminous supernovae in faint galaxies from the first year of the Pan-STARRS1 Medium Deep Survey

The Pan-STARRS1 (PS1) survey has obtained imaging in five bands (grizyP1) over 10 Medium Deep Survey (MDS) fields covering a total of 70 square degrees. This paper describes the search for apparently hostless supernovae (SNe) within the first year of PS1 MDS data with an aim of discovering superluminous supernovae (SLSNe). A total of 249 hostless transients were discovered down to a limiting magnitude of MAB ∼ 23.5, of which 76 were classified as Type Ia supernovae (SNe Ia). There were 57 SNe with complete light curves that are likely core-collapse SNe (CCSNe) or type Ic SLSNe and 12 of these have had spectra taken. Of these 12 hostless, non-Type Ia SNe, 7 were SLSNe of type Ic at redshifts between 0.5 and 1.4. This illustrates that the discovery rate of type Ic SLSNe can be maximized by concentrating on hostless transients and removing normal SNe Ia. We present data for two possible SLSNe; PS1-10pm (z = 1.206) and PS1-10ahf (z = 1.1), and estimate the rate of type Ic SLSNe to be between 3+3−2×10−53+3−2×10−53+3−2×10−5 and 8+2−1×10−58+2−1×10−58+2−1×10−5 that of the CCSN rate within 0.3 ≤ z ≤ 1.4 by applying a Monte Carlo technique. The rate of slowly evolving, type Ic SLSNe (such as SN2007bi) is estimated as a factor of 10 lower than this range.

Proposed role for COUP-TFII in regulating fetal Leydig cell steroidogenesis, perturbation of which leads to masculinization disorders in rodents

Reproductive disorders that are common/increasing in prevalence in human males may arise because of deficient androgen production/action during a fetal 'masculinization programming window'. We identify a potentially important role for Chicken Ovalbumin Upstream Promoter-Transcription Factor II (COUP-TFII) in Leydig cell (LC) steroidogenesis that may partly explain this. In rats, fetal LC size and intratesticular testosterone (ITT) increased ~3-fold between e15.5-e21.5 which associated with a progressive decrease in the percentage of LC expressing COUP-TFII. Exposure of fetuses to dibutyl phthalate (DBP), which induces masculinization disorders, dose-dependently prevented the age-related decrease in LC COUP-TFII expression and the normal increases in LC size and ITT. We show that nuclear COUP-TFII expression in fetal rat LC relates inversely to LC expression of steroidogenic factor-1 (SF-1)-dependent genes (StAR, Cyp11a1, Cyp17a1) with overlapping binding sites for SF-1 and COUP-TFII in their promoter regions, but does not affect an SF-1 dependent LC gene (3β-HSD) without overlapping sites. We also show that once COUP-TFII expression in LC has switched off, it is re-induced by DBP exposure, coincident with suppression of ITT. Furthermore, other treatments that reduce fetal ITT in rats (dexamethasone, diethylstilbestrol (DES)) also maintain/induce LC nuclear expression of COUP-TFII. In contrast to rats, in mice DBP neither causes persistence of fetal LC COUP-TFII nor reduces ITT, whereas DES-exposure of mice maintains COUP-TFII expression in fetal LC and decreases ITT, as in rats. These findings suggest that lifting of repression by COUP-TFII may be an important mechanism that promotes increased testosterone production by fetal LC to drive masculinization. As we also show an age-related decline in expression of COUP-TFII in human fetal LC, this mechanism may also be functional in humans, and its susceptibility to disruption by environmental chemicals, stress and pregnancy hormones could explain the origin of some human male reproductive disorders.

Covering over the cracks in conservation assessments at EU interfaces: A cross-jurisdictional ecoregion scale approach using the Eurasian otter (Lutra lutra)

Throughout the European Union, the EC Habitats Directive requires that member states undertake national surveillance of designated species. Despite biological connections between-populations across-borders, national assessments need not be co-ordinated in any way. We conducted a trans-boundary assessment of the status of Eurasian otters (Lutra lutra) aimed at providing consistency across a single biogeographical unit, i.e. the island of Ireland, comprising two states, i.e. the Republic of Ireland and the United Kingdom (Northern Ireland). Our aim was to ensure consistency with previous assessments conducted separately in each state, and permit each Government to fulfil their separate statutory reporting commitments. The species range increased by 23% from 1996–2006 and 2007–11. The population estimate of 9400 [95%CI 8700–12,200] breeding females during 2010/11 was not significantly different from 8300 [95%CI 7600–9800] breeding females established as a baseline during 1981–82. Modelling of species-habitat associations suggested that available habitat was not limiting and no putative pressures recorded at sites surveyed negatively affected species occurrence. Thus, under the statutory parameters for assessing a species’ conservation status, i.e. range, population, habitat and future prospects, the otter was judged to be in ‘Favourable’ status throughout Ireland and in both discrete political jurisdictions. Thus, we provide a trans-boundary test case for EU member states that share habitats and species across ecoregions, ensuring conservation assessment data are standardised, synchronised, spatially consistent and, therefore, biologically relevant without compromising legal and administrative autonomy within separate jurisdictions.

Interpretation of flat FRP coupon test results

The tensile strength obtained from existing testing methods such as ASTM D3039, based on flat coupons, usually has a large scatter for fibre reinforced polymer (FRP) composites. This means that the measured strength may not represent the actual strength of the material, leading to under or over design. This paper develops a new interpretation method which requires fewer tests, saving money and time. Moreover the results are more consistent and more closely represent the actual strength which can lead to a safer and more economical design.

Towards a general framework for social media research using big data

The increasing adoption of cloud computing, social networking, mobile and big data technologies provide challenges and opportunities for both research and practice. Researchers face a deluge of data generated by social network platforms which is further exacerbated by the co-mingling of social network platforms and the emerging Internet of Everything. While the topicality of big data and social media increases, there is a lack of conceptual tools in the literature to help researchers approach, structure and codify knowledge from social media big data in diverse subject matter domains, many of whom are from nontechnical disciplines. Researchers do not have a general-purpose scaffold to make sense of the data and the complex web of relationships between entities, social networks, social platforms and other third party databases, systems and objects. This is further complicated when spatio-temporal data is introduced. Based on practical experience of working with social media datasets and existing literature, we propose a general research framework for social media research using big data. Such a framework assists researchers in placing their contributions in an overall context, focusing their research efforts and building the body of knowledge in a given discipline area using social media data in a consistent and coherent manner.

Pupillary threshold as an index of population vitamin A status among children in India

Two hundred seven vitamin A-deficient southern Indian children aged 1-7 y (mean age: 56.9 mo) underwent testing of dark-adapted visual and pupillary thresholds in their village setting according to a previously reported protocol. One hundred thirty (62.8%) of the children also underwent serum retinol testing, and 178 (86.0%) participated in a randomized, placebo-controlled vitamin A dosing trial with pre- and postdose testing of dark-adaptation threshold. Most subjects (184 of 207, 88.9%) were able to complete pupillary testing, an objective sign requiring minimal cooperation, including a high proportion of the youngest children (72.2% of subjects aged 2 y). The proportion of children completing visual threshold testing, which requires greater understanding and cooperation, was significantly smaller than that able to complete pupillary testing (131 of 207, 63.3%; P < 0.0001, chi square). At baseline (predosing), the mean serum retinol concentration declined in linear fashion with a higher pupillary threshold (0.73 mumol/L with a score < or = 4; 0.47 mumol/L with a score > or = 8; P < 0.01). The mean pupillary threshold for these highly vitamin A-deficient Indian children (-0.622 log cd/m2) was significantly higher than that for 136 more moderately deficient Indonesian children (-0.985 log cd/m2; P < 0.001, two-sample t test) and 56 normal American children (-1.335 log cd/m2; P < 0.0001, two-sample t test). The improvement in pupillary dark-adaptation testing was not significant for children receiving vitamin A or placebo, though there was a nonsignificant trend toward greater improvement in children receiving vitamin A (P = 0.2, two-sample t test). Pupillary threshold testing represents a new, noninvasive, practical, and seemingly valid approach to assessing the vitamin A status of a moderately to severely deficient preschool population.

A novel TRNSYS type for short-term borehole heat exchanger simulation: B2G model

Models of ground source heat pump (GSHP) systems are used as an aid for the correct design and optimization of the system. For this purpose, it is necessary to develop models which correctly reproduce the dynamic thermal behavior of each component in a short-term basis. Since the borehole heat exchanger (BHE) is one of the main components, special attention should be paid to ensuring a good accuracy on the prediction of the short-term response of the boreholes. The BHE models found in literature which are suitable for short-term simulations usually present high computational costs. In this work, a novel TRNSYS type implementing a borehole-to-ground (B2G) model, developed for modeling the short-term dynamic performance of a BHE with low computational cost, is presented. The model has been validated against experimental data from a GSHP system located at Universitat Politècnica de València, Spain. Validation results show the ability of the model to reproduce the short-term behavior of the borehole, both for a step-test and under normal operating conditions.

Técnica de canto lírico e de teatro musical: práticas de crossover

O presente trabalho tem como objectivo estudar as práticas de crossover entre as técnicas vocais que os cantores líricos e de teatro musical utilizam, assim como as técnicas vocais subjacentes às referidas práticas. Descrevem-se as técnicas vocais utilizadas no canto lírico e no teatro musical por pedagogos que fundamentam o seu trabalho com as descobertas da investigação na área da voz, e comparam-se as referidas técnicas para entender quais os pontos comuns e quais os pontos divergentes. Devido à elevada percentagem de pontos comuns às duas técnicas concluiu-se que são muito próximas entre si, o que faz sentido por serem executadas pela mesma estrutura fisiológica. Apresentam-se as entrevistas efectuadas a cantores profissionais de canto lírico e de teatro musical sobre os aspectos fundamentais das técnicas vocais que utilizam e como fazem o crossover entre as mesmas. Dos resultados dos inquéritos concluiu-se que a maioria dos cantores utiliza habitualmente práticas de crossover na sua performance. A segunda conclusão retirada dos resultados do inquérito foi que a execução das referidas práticas é intuitiva na maioria dos casos, e não conscientemente efectuada. Apresenta-se um caso de aplicação em contexto performativo das práticas de crossover: o papel do soprano na cantata cénica "Moby Dick - Aos Peixes". A utilização tecnicamente consciente das práticas de crossover permitiu estabilizar a execução vocal desde o início dos ensaios e obter posteriormente uma performance consistente mas versátil, sem fixar a execução vocal ao longo da carreira do espectáculo. Os apêndices incluem informação anatomofisiológica útil para este estudo, um resumo dos métodos de estudo científico da voz, o questionário utilizado no inquérito, as tabelas dos dados obtidos, a partitura anotada de "Aos Peixes" e o DVD do espectáculo realizado no Centro Cultural de Belém, em Lisboa. ABSTRACT: The present work aims to understand the crossover mecanisms that the classical singers and the musical theatre singers use, and the vocal techniques underlying those practices. This work describes the vocal techniques taught in the lyrical singing and in the musical theatre singing by teachers who base their pedagogy on the findings of scientific investigation of voice and singing. The techniques used in both fields are compared to understand their similarities and diferences. This process led to the conclusion that both techniques are very close, due to the high percentage of common items found, and this makes sense since both techniques are produced by the same physiologic struture: the vocal system. Professional singers from the lyrical and the musical theatre scene were interviewed to explain the basic foundations of their vocal technique and how do they do the crossover between those styles, from a technical point of view. The results of these interviews led to the conclusion that the majority of the singers performs crossover actions in their singing. The second conclusion is that for the majority of singers these crossover actions are intuitive, inspired by the music, the text or the dramatic context, and not informed by technically conscious actions. It is presented a case study of how these crossover methods were used in a staged cantata: the soprano role in "Moby Dick - Aos Peixes". The use of conscious technically informed crossover practice allowed to stabilize the vocal execution right from the beginning of rehearsals and obtain afterwards a performance which was both consistent and versatile, not fixed, during the running of the show. The appendixes include useful anatomical and physiological information, a summary of the methods of the scientific study of voice, the formulary used in the enquiry, the data tables of the field work, the annotated score of "Moby Dick - Aos Peixes" and the DVD from the play filmed at Centro Cultural de Belém, in Lisbon.

A morte e o luto em contexto escolar: das vivências na primeira pessoa à (re) significação do conceito de escola acolhedora

A morte é, porventura, o grande tabu da sociedade ocidental contemporânea, fenómeno com clara ressonância na forma como os sobreviventes vivenciam o luto por perda de figura significativa. Numa sociedade que se mantém à margem da morte, as emoções decorrentes do luto são escamoteadas e reprimidas, com sérios riscos para a saúde mental dos enlutados. Essa conspiração do silêncio desagua também nos contextos educativos, onde os valores da juventude, do bem-estar, do prazer e da felicidade, quase não deixam espaço para o sofrimento e a morte. Deste modo, este estudo pretende ser uma contribuição para a compreensão dos efeitos do processo de luto em alunos adolescentes, nomeadamente ao nível do seu desempenho escolar, e, concomitantemente, para a análise do tipo de apoio que a comunidade educativa proporciona a esses alunos, com enfoque no papel dos professores (em geral) e dos diretores de turma (em particular). Pretende ainda apresentar estratégias interventivas, a implementar nas escolas, potenciadoras de uma educação para a vida, mesmo em circunstâncias de morte, e para a gestão do luto, que se revelem promotoras de um lidar pedagógico inclusivo. Sendo o luto um processo que afeta o indivíduo em todas as dimensões que o definem, um paradigma educacional que encontre na complexidade a sua matriz identitária, foi assumido neste estudo como o único capaz de resgatar a importância da gestão equilibrada dos afetos no processo de ensinoaprendizagem. À luz deste paradigma que assume um princípio de totalidade, partindo da totalidade, ou seja, que promove o desenvolvimento do ser humano na sua multidimensionalidade, assumimos também que a missão suprema e última da educação é a construção do sujeito ético. E é nos marcos de uma educação integral, humanista e ética, de responsabilidade pelo Outro, que ganha contornos a figura do professor cuidador, como sendo alguém atento às necessidades emocionais dos seus alunos. Do ponto de vista metodológico, esta investigação desenvolveu-se de acordo com uma abordagem de natureza predominantemente qualitativa, interpretativa e complexa e o estudo realizado centrou-se em três fases, tendo a recolha de dados decorrido entre setembro de 2009 e setembro de 2012: (i) Estudo exploratório, dirigido aos Diretores das 61 escolas secundárias do Distrito do Porto, com base num questionário adaptado, com o objetivo de sustentar a importância e pertinência do estudo principal e recolher indicadores para o orientar; (ii) Estudo de Caso Coletivo, envolvendo três alunas adolescentes em luto por perda de pai. Na primeira parte, e com vista à caracterização do contexto, a escola frequentada pelas três alunas, procedeuse à análise documental, concretamente do Projeto Educativo, mas também ao inquérito por entrevista a vários agentes da comunidade educativa: o Diretor, a Psicóloga, a Coordenadora dos Diretores de Turma do ensino secundário e seis Diretores de Turma. Na segunda parte, procedeu-se a uma abordagem holística e aprofundada da complexidade inerente a cada caso, procurando dar “voz” à forma única como cada uma das alunas vivenciou, significou e enfrentou a sua experiência de luto, tendo-se recorrido ao inquérito por entrevista. De forma a cruzar perspetivas de vários informantes, e identificar significados transversais, complementares ou alternativos, foram também entrevistadas as Encarregadas de Educação e os Diretores de Turma das alunas; (iii) Caraterização das conceções de professores sobre a temática em análise e validação de propostas de intervenção a implementar nas escolas, mobilizando-se, assim, dimensões emergentes das Fases I e II da investigação, mas também do quadro teórico que sustentou o estudo. Para a recolha de dados, foi construído um questionário que se aplicou aos professores do 2º e 3º ciclos do ensino básico e ensino secundário do Agrupamento onde se centrou o estudo de caso desenvolvido na Fase II. Procurando uma leitura global dos resultados obtidos e corroborando o que é amplamente defendido na literatura da especialidade, o estudo demonstra o impacto negativo que o luto tem no desempenho escolar e revela que o padrão afetivo da ambiência escolar não é favorável à expressão emocional de alunos enlutados, prevalecendo uma atitude de evitação por parte dos colegas e professores, o que sugere a necessidade de serem trilhados novos caminhos, por um lado, ao nível da formação de professores e, por outro lado, através da implementação em contexto escolar de uma intervenção pedagógica que eduque para a vida, mas sem descurar os fenómenos de perda afetiva significativa e respetivas vivências de luto. Deste estudo sai também reforçada a responsabilidade acrescida dos Diretores de Turma na constituição de um ethos de suporte envolvendo alunos em luto, cabendo-lhes um importante papel na articulação entre os vários agentes da comunidade educativa. Em suma: para além da necessidade de repensar o perfil de competências dos professores, mais consentâneo com o paradigma de escola acolhedora, deste estudo ressalta também a premência de validar na prática propostas de intervenção articuladas, consistentes e, sobretudo, éticas.