Quality assurance in the EORTC 22033-26033/CE5 phase III randomized trial for low grade glioma: the digital individual case review.

INTRODUCTION: The phase III EORTC 22033-26033/NCIC CE5 intergroup trial compares 50.4 Gy radiotherapy with up-front temozolomide in previously untreated low-grade glioma. We describe the digital EORTC individual case review (ICR) performed to evaluate protocol radiotherapy (RT) compliance. METHODS: Fifty-eight institutions were asked to submit 1-2 randomly selected cases. Digital ICR datasets were uploaded to the EORTC server and accessed by three central reviewers. Twenty-seven parameters were analysed including volume delineation, treatment planning, organ at risk (OAR) dosimetry and verification. Consensus reviews were collated and summary statistics calculated. RESULTS: Fifty-seven of seventy-two requested datasets from forty-eight institutions were technically usable. 31/57 received a major deviation for at least one section. Relocation accuracy was according to protocol in 45. Just over 30% had acceptable target volumes. OAR contours were missing in an average of 25% of cases. Up to one-third of those present were incorrectly drawn while dosimetry was largely protocol compliant. Beam energy was acceptable in 97% and 48 patients had per protocol beam arrangements. CONCLUSIONS: Digital RT plan submission and review within the EORTC 22033-26033 ICR provide a solid foundation for future quality assurance procedures. Strict evaluation resulted in overall grades of minor and major deviation for 37% and 32%, respectively.

Objective comparison of image quality and dose between conventional and synchrotron radiation mammography.

The shape of the energy spectrum produced by an x-ray tube has a great importance in mammography. Many anode-filtration combinations have been proposed to obtain the most effective spectrum shape for the image quality-dose relationship. On the other hand, third generation synchrotrons such as the European Synchrotron Radiation Facility in Grenoble are able to produce a high flux of monoenergetic radiation. It is thus a powerful tool to study the effect of beam energy on image quality and dose in mammography. An objective method was used to evaluate image quality and dose in mammography with synchrotron radiation and to compare them to standard conventional units. It was performed systematically in the energy range of interest for mammography through the evaluation of a global image quality index and through the measurement of the mean glandular dose. Compared to conventional mammography units, synchrotron radiation shows a great improvement of the image quality-dose relationship, which is due to the beam monochromaticity and to the high intrinsic collimation of the beam, which allows the use of a slit instead of an anti-scatter grid for scatter rejection.

Impact of thermal proofing of a church on its indoor air-quality - The combustion of candles and incense as a source of pollution

Some years ago, a parish in Geneva decided to reduce heating costs by insulating its church to make it more energy efficient. Three years after the last renovations, it was observed that the internal surfaces of the naves had already become dusty compared with the customary frequency of 10-12 years. Dust even deposited on various surfaces during religious services. Our investigation showed that nearly all the dust found inside the church may in fact be soot from incense and candle combustion. Incense appears to be a significant source of polycyclic aromatic hydrocarbons. With a mechanical ventilation system and petrol lamps resembling candles the problem can be resolved.

Lipid (energy) reserves of european hake (Merluccius Merluccius) in the North-Western Mediterranean

This study analyses for the first time the lipid (energy) reserves of European hake (Merluccius merluccius) in the north-western Mediterranean from an ecophysiological perspective. Results show that there is a progressive accumulation of lipids in the liver of maturing hake -where the bulk of the fat is stored- as individuals grow. Results also indicate that female pre-spawners expend much energy on reproductive activities since they present lower liver lipid reserves than juveniles and maturing individuals. Furthermore, results show that female pre-spawners with higher lipid reserves in their livers had a higher amount of lipids in their ovaries, suggesting that maternal condition (spawner quality) may affect the reproductive potential of hake. Overall, the results of this study suggest that the analysis of liver lipid reserves during pre-spawning, along with the evaluation of the gonadosomatic index and the consideration of the reproductive stage, can contribute to improve the estimation of the reproductive potential of gadoid species such as hake

An approach to costs and energy consumption in private urban Spanish Mediterranean landscapes from a simplified model in sprinkle irrigation

The number of private gardens has increased in recent years, creating a more pleasant urban model, but not without having an environmental impact, including increased energy consumption, which is the focus of this study. The estimation of costs and energy consumption for the generic typology of private urban gardens is based on two simplifying assumptions: square geometry with surface areas from 25 to 500 m2 and hydraulic design with a single pipe. In total, eight sprinkler models have been considered, along with their possible working pressures, and 31 pumping units grouped into 5 series that adequately cover the range of required flow rates and pressures, resultin in 495 hydraulic designs repeated for two climatically different locations in the Spanish Mediterranean area (Girona and Elche). Mean total irrigation costs for the locality with lower water needs (Girona) and greater needs (Elche) were € 2,974 ha-¹ yr-¹ and € 3,383 ha-¹ yr-¹, respectively. Energy costs accounted for 11.4% of the total cost for the first location, and 23.0% for the second. While a suitable choice of the hydraulic elements of the setup is essential, as it may provide average energy savings of 77%, due to the low energy cost in relation to the cost of installation, the potential energy savings do not constitute a significant incentive for the irrigation system design. The low efficiency of the pumping units used in this type of garden is the biggest obstacle and constraint to achieving a high quality energy solution

Health-related quality of life in survivors of childhood cancer: the role of chronic health problems.

INTRODUCTION: The influence of specific health problems on health-related quality of life (HRQoL) in childhood cancer survivors is unknown. We compared HRQoL between survivors of childhood cancer and their siblings, determined factors associated with HRQoL, and investigated the influence of chronic health problems on HRQoL. METHODS: Within the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to all survivors (≥16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2005 aged <16 years. Siblings received similar questionnaires. We assessed HRQoL using Short Form-36 (SF-36). Health problems from a standard questionnaire were classified into overweight, vision impairment, hearing, memory, digestive, musculoskeletal or neurological, and thyroid problems. RESULTS: The sample included 1,593 survivors and 695 siblings. Survivors scored significantly lower than siblings in physical function, role limitation, general health, and the Physical Component Summary (PCS). Lower score in PCS was associated with a diagnosis of central nervous system tumor, retinoblastoma or bone tumor, having had surgery, cranio-spinal irradiation, or bone marrow transplantation. Lower score in Mental Component Summary was associated with older age. All health problems decreased HRQoL in all scales. Most affected were survivors reporting memory problems and musculoskeletal or neurological problems. Health problems had the biggest impact on physical functioning, general health, and energy and vitality. CONCLUSIONS: In this study, we showed the negative impact of specific chronic health problems on survivors' HRQoL. IMPLICATIONS FOR CANCER SURVIVORS: Therapeutic preventive measures, risk-targeted follow-up, and interventions might help decrease health problems and, consequently, improve survivors' quality of life.

Energy-weighted sum rules for mesons in hot and dense matter

We study energy-weighted sum rules of the pion and kaon propagator in nuclear matter at finite temperature. The sum rules are obtained from matching the Dyson form of the meson propagator with its spectral Lehmann representation at low and high energies. We calculate the sum rules for specific models of the kaon and pion self-energy. The in-medium spectral densities of the K and (K) over bar mesons are obtained from a chiral unitary approach in coupled channels that incorporates the S and P waves of the kaon-nucleon interaction. The pion self-energy is determined from the P-wave coupling to particle-hole and Delta-hole excitations, modified by short-range correlations. The sum rules for the lower-energy weights are fulfilled satisfactorily and reflect the contributions from the different quasiparticle and collective modes of the meson spectral function. We discuss the sensitivity of the sum rules to the distribution of spectral strength and their usefulness as quality tests of model calculations.

Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD Official Positions.

Peripheral assessment of bone density using photon absorptiometry techniques has been available for over 40 yr. The initial use of radio-isotopes as the photon source has been replaced by the use of X-ray technology. A wide variety of models of single- or dual-energy X-ray measurement tools have been made available for purchase, although not all are still commercially available. The Official Positions of the International Society for Clinical Densitometry (ISCD) have been developed following a systematic review of the literature by an ISCD task force and a subsequent Position Development Conference. These cover the technological diversity among peripheral dual-energy X-ray absorptiometry (pDXA) devices; define whether pDXA can be used for fracture risk assessment and/or to diagnose osteoporosis; examine whether pDXA can be used to initiate treatment and/or monitor treatment; provide recommendations for pDXA reporting; and review quality assurance and quality control necessary for effective use of pDXA.

Influence of scatter reduction method and monochromatic beams on image quality and dose in mammography.

In mammography, the image contrast and dose delivered to the patient are determined by the x-ray spectrum and the scatter to primary ratio S/P. Thus the quality of the mammographic procedure is highly dependent on the choice of anode and filter material and on the method used to reduce the amount of scattered radiation reaching the detector. Synchrotron radiation is a useful tool to study the effect of beam energy on the optimization of the mammographic process because it delivers a high flux of monochromatic photons. Moreover, because the beam is naturally flat collimated in one direction, a slot can be used instead of a grid for scatter reduction. We have measured the ratio S/P and the transmission factors for grids and slots for monoenergetic synchrotron radiation. In this way the effect of beam energy and scatter rejection method were separated, and their respective importance for image quality and dose analyzed. Our results show that conventional mammographic spectra are not far from optimum and that the use of a slot instead of a grid has an important effect on the optimization of the mammographic process. We propose a simple numerical model to quantify this effect.

Inclusion of soil erosion impacts in life cycle assessment on a global scale: application to energy crops in Spain

Purpose: Despite the fundamental role of ecosystem goods and services in sustaining human activities, there is no harmonized and internationally agreed method for including them in life cycle assessment (LCA). The main goal of this study was to develop a globally applicable and spatially resolved method for assessing land-use impacts on the erosion regulation ecosystem service.Methods: Soil erosion depends much on location. Thus, unlike conventional LCA, the endpoint method was regionalized at the grid-cell level (5 arc-minutes, approximately 10×10 km2) to reflect the spatial conditions of the site. Spatially explicit characterization factors were not further aggregated at broader spatial scales. Results and discussion: Life cycle inventory data of topsoil and topsoil organic carbon (SOC) losses were interpreted at the endpoint level in terms of the ultimate damage to soil resources and ecosystem quality. Human health damages were excluded from the assessment. The method was tested on a case study of five three-year agricultural rotations, two of them with energy crops, grown in several locations in Spain. A large variation in soil and SOC losses was recorded in the inventory step, depending on climatic and edaphic conditions. The importance of using a spatially explicit model and characterization factors is shown in the case study.Conclusions and outlook: The regionalized assessment takes into account the differences in soil erosion-related environmental impacts caused by the great variability of soils. Taking this regionalized framework as the starting point, further research should focus on testing the applicability of the method trough the complete life cycle of a product and on determining an appropriate spatial scale at which to aggregate characterization factors, in order to deal with data gaps on location of processes, especially in the background system. Additional research should also focus on improving reliability of the method by quantifying and, insofar as it is possible, reducing uncertainty.

Performance and hormonal profile in broiler chickens fed with different energy levels during post restriction period

The aim of this work was to investigate the influence of diet energy level on performance and hormonal profiles of broilers during post restriction period. It was a split-plot experiment, and the main treatments were in a 2x2 factorial scheme. Birds were fed restricted to 30% of the ad libitum intake, from 7 to 14 days of age. After the restriction period, birds were fed ad libitum with diets containing low (2,900 kcal ME/kg) or high (3,200 kcal ME/kg) energy until 49 days of age. Broilers fed with high energy ration showed lower feed intake and better feed conversion and decreased carcass protein; however, abdominal fat pad, and total carcass fat were not affected by ration energy levels or feeding program. Neither diet energy level nor feed restriction program changed body weight at 49 days. The profile of insulin-like growth factor-1 (IGF-1) was reduced during the feed restriction period, but increased at refeeding period. Feeding program and ration energy level did not affect T3, T4 and growth hormone serum concentrations. Feed restriction at 30% of ad libitum intake is not enough to promote changes on carcass quality, related to fat deposition, and on metabolic hormone levels, except IGF-1 seric level that has rapid increase after feed restriction.

Development of Quality Standards for Inclusion of High Recycled Asphalt Pavement Content in Asphalt Mixtures – Phase II, TR-658, 2015

To conserve natural resources and energy, the amount of recycled asphalt pavement has been steadily increasing in the construction of asphalt pavements. The objective of this study is to develop quality standards for inclusion of high RAP content. To determine if the higher percentage of RAP materials can be used on Iowa’s state highways, three test sections with target amounts of RAP materials of 30%, 35% and 40% by weight were constructed on Highway 6 in Iowa City. To meet Superpave mix design requirements for mixtures with high RAP contents, it was necessary to fractionate the RAP materials. Three test sections with actual RAP materials of 30.0%, 35.5% and 39.2% by weight were constructed and the average field densities from the cores were measured as 95.3%, 94.0%, and 94.3%, respectively. Field mixtures were compacted in the laboratory to evaluate moisture sensitivity using a Hamburg Wheel Tracking Device. After 20,000 passes, rut depths were less than 3mm for mixtures obtained from three test sections. The binder was extracted from the field mixtures from each test section and tested to identify the effects of RAP materials on the performance grade of the virgin binder. Based on Dynamic Shear Rheometer and Bending Beam Rheometer tests, the virgin binders (PG 64-28) from test sections with 30.0%, 35.5% and 39.2% RAP materials were stiffened to PG 76-22, PG 76-16, and PG 82-16, respectively. The Semi-Circular Bending (SCB) test was performed on laboratory compacted field mixtures with RAP amounts of 30.0%, 35.5% and 39.2% at two different temperatures of -18 and -30 °C. As the test temperature decreased, the fracture energy decreased and the stiffness increased. As the RAP amount increased, the stiffness increased and the fracture energy decreased. Finally, a condition survey of the test sections was conducted to evaluate their short-term pavement performance and the reflective transverse cracking did not increase as RAP amount was increased from 30.0% to 39.2%.

Toward partial redirection of energy policy for responsible development

This paper addresses the surprising lack of quality control on the analysis and selection on energy policies observable in the last decades. As an example, we discuss the delusional idea that it is possible to replace fossil energy with large scale ethanol production from agricultural crops. But if large scale ethanol production is not practical in energetic terms, why huge amount of money has been invested in it and is it still being invested? In order to answer this question we introduce two concepts useful to frame, in general terms, the predicament of quality control in science: (i) the concept of “granfalloons” proposed by K. Vonnegut (1963) flagging the danger of the formation of “crusades to save the world” void of real meaning. These granfalloons are often used by powerful lobbies to distort policy decisions; and (ii) the concept of Post-Normal science by S. Funtowicz and J. Ravetz (1990) indicating a standard predicament faced by science when producing information for governance. When mixing together uncertainty, multiple-scale and legitimate but contrasting views it becomes impossible to deal with complex issue using the conventional scientific approach based on reductionism. We finally discuss the implications of a different approach to the assessment of alternative energy sources by introducing the concept of Promethean technology.

Occupational and patient exposure as well as image quality for full spine examinations with the EOS imaging system.

PURPOSE: EOS (EOS imaging S.A, Paris, France) is an x-ray imaging system that uses slot-scanning technology in order to optimize the trade-off between image quality and dose. The goal of this study was to characterize the EOS system in terms of occupational exposure, organ doses to patients as well as image quality for full spine examinations. METHODS: Occupational exposure was determined by measuring the ambient dose equivalents in the radiological room during a standard full spine examination. The patient dosimetry was performed using anthropomorphic phantoms representing an adolescent and a five-year-old child. The organ doses were measured with thermoluminescent detectors and then used to calculate effective doses. Patient exposure with EOS was then compared to dose levels reported for conventional radiological systems. Image quality was assessed in terms of spatial resolution and different noise contributions to evaluate the detector's performances of the system. The spatial-frequency signal transfer efficiency of the imaging system was quantified by the detective quantum efficiency (DQE). RESULTS: The use of a protective apron when the medical staff or parents have to stand near to the cubicle in the radiological room is recommended. The estimated effective dose to patients undergoing a full spine examination with the EOS system was 290μSv for an adult and 200 μSv for a child. MTF and NPS are nonisotropic, with higher values in the scanning direction; they are in addition energy-dependent, but scanning speed independent. The system was shown to be quantum-limited, with a maximum DQE of 13%. The relevance of the DQE for slot-scanning system has been addressed. CONCLUSIONS: As a summary, the estimated effective dose was 290μSv for an adult; the image quality remains comparable to conventional systems.

Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.

BACKGROUND: Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome. METHODS: This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days. We calculated energy targets with indirect calorimetry on day 3, or if not possible, set targets as 25 and 30 kcal per kg of ideal bodyweight a day for women and men, respectively. Patients were randomly assigned (1:1) by a computer-generated randomisation sequence to receive EN or SPN. The primary outcome was occurrence of nosocomial infection after cessation of intervention (day 8), measured until end of follow-up (day 28), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00802503. FINDINGS: We randomly assigned 153 patients to SPN and 152 to EN. 30 patients discontinued before the study end. Mean energy delivery between day 4 and 8 was 28 kcal/kg per day (SD 5) for the SPN group (103% [SD 18%] of energy target), compared with 20 kcal/kg per day (7) for the EN group (77% [27%]). Between days 9 and 28, 41 (27%) of 153 patients in the SPN group had a nosocomial infection compared with 58 (38%) of 152 patients in the EN group (hazard ratio 0·65, 95% CI 0·43-0·97; p=0·0338), and the SPN group had a lower mean number of nosocomial infections per patient (-0·42 [-0·79 to -0·05]; p=0·0248). INTERPRETATION: Individually optimised energy supplementation with SPN starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strategy to improve clinical outcome in patients in the ICU for whom EN is insufficient. FUNDING: Foundation Nutrition 2000Plus, ICU Quality Funds, Baxter, and Fresenius Kabi.