Radiosurgery for brain metastases: specific indications for Gamma Knife in lieu of Linac in a single center using both methods

INTRODUCTION: Radiosurgery (RS) is gaining increasing acceptance in the upfront management of brain metastases (BM). It was initially used in so-called radioresistant metastases (melanoma, renal cell, sarcoma) because it allowed delivering higher dose to the tumor. Now, RS is also used for BM of other cancers. The risk of high incidence of new BM questions the need for associated whole-brain radiotherapy (WBRT). Recent evidence suggests that RS alone allows avoiding cognitive impairment related to WBRT, and the latter should be upheld for salvage therapy. Thus the increase use of RS for single and multiple BM raises new technical challenges for treatment delivery and dosimetry. We present our single institution experience focusing on the criteria that led to patients' selection for RS treatment with Gamma Knife (GK) in lieu of Linac. METHODS: Leksell Gamma Knife Perfexion (Elekta, Sweden) was installed in July 2010. Currently, the Swiss federal health care supports the costs of RS for BM with Linac but not with GK. Therefore, in our center, we always consider first the possibility to use Linac for this indication, and only select patients for GK in specific situations. All cases of BM treated with GK were retrospectively reviewed for criteria yielding to GK indication, clinical information, and treatment data. Further work in progress includes a posteriori dosimetry comparison with our Linac planning system (Brainscan V.5.3, Brainlab, Germany). RESULTS: From July 2010 to March 2012, 20 patients had RS for BM with GK (7 patients with single BM, and 13 with multiple BM). During the same period, 31 had Linac-based RS. Primary tumor was melanoma in 9, lung in 7, renal in 2, and gastrointestinal tract in 2 patients. In single BM, the reason for choosing of GK was the anatomical location close to, or in highly functional areas (1 motor cortex, 1 thalamic, 1 ventricular, 1 mesio-temporal, 3 deep cerebellar close to the brainstem), especially since most of these tumors were intended to be treated with high-dose RS (24 Gy at margin) because of their histology (3 melanomas, 1 renal cell). In multiple BM, the reason for choosing GK in relation with the anatomical location of the lesions was either technical (limitations of Linac movements, especially in lower posterior fossa locations) or closeness of multiple lesions to highly functional areas (typically, multiple posterior fossa BM close to the brainstem), precluding optimal dosimetry with Linac. Again, this was made more critical for multiple BM needing high-dose RS (6 melanoma, 2 hypernephroma). CONCLUSION: Radiosurgery for BM may represent some technical challenge in relation with the anatomical location and multiplicity of the lesions. These considerations may be accentuated for so-called radioresistant BM, when higher dose RS in needed. In our experience, Leksell Gamma Knife Perfexion proves to be useful in addressing these challenges for the treatment of BM.

Using consumer search cost and loyalty to explain dispersion in banking fees

Pode-se observar uma considerável dispersão entre os preços que diferentes bancos comerciais no Brasil cobram por um mesmo pacote homogêneo de serviços— dispersão esta que é sustentada ao longo do tempo. Em uma tentativa de replicar esta observação empírica, foi desenvolvido um simples modelo que lança mão do arcabouço da literatura de custos de procura (search costs) e que baseia-se também na lealdade por parte dos consumidores. Em seguida, dados de preços referentes ao setor bancário brasileiro são aplicados ao modelo desenvolvido e alguns exercícios empíricos são então realizados. Esses exercícios permitem que: (i) os custos de procura incorridos pelos consumidores sejam estimados, ao fixar-se os valores dos demais parâmetros e (ii) as correspondentes perdas de peso-morto que surgem como consequência dos custos de procura incorridos pelos consumidores sejam também estimadas. Quando apenas 80% da população é livre para buscar por bancos que cobrem menores tarifas, à taxa de juros mensal de 0,5%, o valor estimado do custo de procura médio incorrido pelos consumidores chega a 1805,80 BRL, sendo a correspondente perda de peso-morto média na ordem de 233,71 BRL por consumidor.

Payments in lieu of taxes to States of local taxing units. Report of the Committee on Government Operations, United States Senate, Eighty-third Congress, second session, on H.R. 5605, an act of 1949 to provide for payment of taxes or payments in lieu of taxes with respect to real property transferred from Government corporations to other agencies of the Federal Government.

Mode of access: Internet.

Effects of changes in grazing fees and permitted use of public rangelands on incomes of western livestock ranches.

Mode of access: Internet.

Payment of taxes, or in lieu of taxes, to State or local taxing units : hearing before the Committee on Government Operations, United States Senate, Eighty-fourth Congress, first[-second] session, on S. 826, S. 888. S. 1566, S. 1657, S. 2100, S. 2377, and S. 2390, bills relating to payments of taxes, or in lieu of taxes to state or local taxing units.

Description based on pt. 1.

Les programmes de compensation de la biodiversité dans l'industrie minière : Analyse multicritère des types de programmes

La biodiversité est une ressource essentielle à la vie humaine sur terre. En effet, elle fournit une multitude de biens et de services dont la société moderne dépend. Toutefois, les pressions anthropiques grandissantes sur les milieux naturels constituent un réel danger pour la santé de la biodiversité mondiale. Parmi ces pressions, il y a l’industrie minière. Afin de diminuer cet impact négatif, plusieurs compagnies, gouvernements et organisations mettent en place des programmes de compensation de la biodiversité. Ces programmes peuvent se réaliser sous plusieurs formes, dont trois qui sont analysées dans cet essai : les projets sur mesure, les banques de compensation et les frais compensatoires. L’objectif de cet essai est d’évaluer la performance de ces trois types de programmes de compensation de la biodiversité afin de déterminer lequel a la meilleure performance selon les critères d’analyse choisis. Les résultats de l’analyse démontrent clairement que les projets sur mesure sont le type de programme qui performe le mieux parmi les trois types à l’étude et selon les critères d’analyse définis. En effet, les projets sur mesure se distinguent notamment en raison du lien direct entre le site dégradé et le site de compensation et par l’implication des parties prenantes qui accompagne normalement ces projets. Les deux autres types de programmes ont eu une moins bonne performance, surtout dans le cas des frais compensatoires. Ce dernier a eu le moins bon résultat, notamment en raison de la dissociation des compagnies minières quant à la réalisation des compensations et du manque d’encadrement des programmes. Les conclusions de l’analyse permettent donc de constater que, lorsque possible, les projets sur mesure sont le meilleur choix en matière de compensation de la biodiversité et qu’ils devraient être appliqués en priorité par rapport aux deux autres types de programmes. De façon générale, indépendamment du type de programme utilisé, quelques recommandations ont été suggérées. Il est notamment recommandé d’assurer l’implication des parties prenantes, d’adhérer à la hiérarchie de mitigation et de miser sur l’équivalence.

Transient evoked otoacoustic emissions in children studying in special schools

Objectives: The present study aimed to investigate the feasibility and practicalities or testing children in special school settings using transient evoked otoacoustic emissions (TEOAE) and tympanometry. Children studying in special schools, particularly those with intellectual impairment, may be highly susceptible to hearing pathologies and can be difficult to assess using traditional test batteries. Researchers have recently suggested the possible applicability of TEOAE testing. in lieu of conventional behavioral methods, as a hearing screening device for persons with intellectual impairment. However, to date. few publications have detailed the particulars and results of such testing. Methods: A total of 489 children, with a mean age of 9.6 years, were tested in 15 special schools. Case information was obtained regarding birth history, medical history and type,degree of impairment, for later comparison with screening results. TEOAEs were collected using Quickscreen mode of the ILO292 Otodynamics Analyzer, whilst tympanometry was performed utilizing a Madsen Zodiac 901 Middle Ear Analyzer. Results: In total, 80% of students were able to be tested using TEOAEs. Average test time per ear was 2 min. However, a large proportion (40 of those able to be tested) failed TEOAE testing in at least one ear. No significant effects were found between could-not-test (CNT) cases and case history factors, A significant difference in TEOAE failure rates was found across history of neonatal special care nursery residency and history of parental concern regarding possible hearing impairment. Failure rates were higher for those who indicated positive histories. A total of 74% of subjects could be tested using tympanometry, with 25% of those able to be tested failing in at least one ear. Notably, neither type nor degree of impairment had any significant bearing on CNT or failure rates for tympanometry or TEOAE screening. Conclusions: Findings of the present investigation lend support to the review of hearing screening programs for children in special schools. with TEOAEs presenting as a potential alternative procedure. Further examination of the performance measures of protocols incorporating TEOAEs would now be advantageous. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Control and host-dependent activation of insect toxin expression in a root-associated biocontrol pseudomonad.

Pseudomonas fluorescens CHA0 is a root-associated biocontrol agent that suppresses soil-borne fungal diseases of crops. Remarkably, the pseudomonad is also endowed with systemic and oral activity against pest insects which depends on the production of the insecticidal Fit toxin. The toxin gene (fitD) is part of a virulence cassette encoding three regulators (FitF, FitG, FitH) and a type I secretion system (FitABC-E). Immunoassays with a toxin-specific antibody and transcriptional analyses involving fitG and fitH deletion and overexpression mutants identified LysR family regulator FitG and response regulator FitH as activator and repressor, respectively, of Fit toxin and transporter expression. To visualize and quantify toxin expression in single live cells by fluorescence microscopy, we developed reporters which in lieu of the native toxin protein express a fusion of the Fit toxin with red fluorescent mCherry. In a wild-type background, expression of the mCherry-tagged Fit toxin was activated at high levels in insect hosts, i.e. when needed, yet not on plant roots or in batch culture. By contrast, a derepressed fitH mutant expressed the toxin in all conditions. P. fluorescens hence can actively induce insect toxin production in response to the host environment, and FitH and FitG are key regulators in this mechanism.

Roadway Lighting on Secondary Roads in Iowa, HR-251, 1984

There are approximately 800 installations of destination lighting at secondary road intersections in Iowa. Approximately 90% of these have only a single luminaire. The other installations have two luminaires. No warrants currently exist for justifying the use of this type of lighting. Previous research has examined the safety benefits from full lighting of rural intersections that generally serve substantially higher traffic volumes than secondary road intersections in Iowa. However, the safety benefit of destination lighting at intersections carrying relatively low volumes has not been the subject of previous research. The research reported here, sponsored by the Iowa Department of Transportation, was undertaken to identify locations where destination lighting could be expected to improve highway safety. If destination lighting were shown to reduce accident frequency, warrants for its use on secondary roads could be developed. An inventory of secondary road lighting installations in Iowa was assembled. From this inventory, two samples were constituted that would permit two separate comparisons of the accident experience with and without destination lighting. Before and after comparisons were made for the same locations if accident records were available for at least one full year both preceding and following the installation of destination lighting. Accident records for this purpose were available from a statewide computerized record system covering the period from 1977 through 1982. The accident experience at locations having destination lighting installed before 1978 was compared with a sample of comparable locations not having destination lighting. The sample of secondary road intersections used for the before and after comparison included 91 locations. The sample of continuously lighted locations included 102 intersections. Accident experience at these locations was compared with the experience at 102 intersections that were not lighted. The intersections included in these samples averaged only 0.31 accidents per year. The accident rate at secondary road intersections that had destination lighting did not differ significantly from the accident rate at intersections that were not lighted. This conclusion was derived from both comparisons, the before and after experience and the comparison of experience at intersections that were continuously lighted with that at unlighted locations. Furthermore, no significant differences were noted between lighted and unlighted locations in the proportion of accidents that occurred at night. The distribution of accidents by type also did not differ between unlighted intersections and those having destination lighting. It was not possible to formulate warrants for destination lighting since analyses directed toward identifying specific characteristics of an intersection that could be correlated with highway safety did not yield any useful relationships. However, it was noted that the average damages for night accidents that occurred at lighted intersections were lower than for accidents at unlighted intersections. Even in the absence of a more definitive demonstration of beneficial effects, destination lighting is perceived by officials in most of the counties having such installations as yielding desirable effects and is recognized as helpful to motorists in performing the guidance function in driving. Given this benefit and a relatively low cost (an average of $74 per year for one luminaire), and given that the subjective criteria that have been used in the past to justify the installation of destination lighting have led to a high degree of public acceptance and satisfaction, it is recommended that the same subjective criteria continue to be used in lieu of definitive warrants.

The Use of Fly Ash in Highway Construction, HR-1031, 1990

In 1982 the Iowa DOT allowed a successful bidder the option of submitting materials and proportions using fly ash to produce a portland cement concrete (PCC) paving mixture to meet a specified compressive strength. The contractor, Irving F. Jensen, received approval for the use of a concrete mixture utilizing 500 lbs. of portland cement and 88 lbs. of fly ash as a replacement of 88 lbs. of portland cement. The PCC mixture was utilized on the Muscatine County US 61 relocation bypass paved as project F-61-4(32)--20-70. A Class "C" fly ash obtained from the Chillicothe electric generating plant approximately 100 miles away was used in the project. This use of fly ash in lieu of portland cement resulted in a cost savings of $64,500 and an energy savings of approximately 16 billion BTU. The compressive strength of this PCC mixture option was very comparable to concrete mixtures produced without the use of fly ash. The pavement has been performing very well. The substitution of fly ash for 15% of the cement has been allowed as a contractor's option since 1984. Due to the cost savings, it has been used in almost all Iowa PCC paving since that time.

The Use of Fly Ash in Highway Construction, HR-1031, Progress Report, 1986

In 1982 the Iowa DOT allowed a successful bidder the option of submitting materials and proportions using fly ash to produce a portland cement concrete (PCC) paving mixture to meet a specified compressive strength. The contractor, Irving F. Jensen, received approval for the use of a concrete mixture utilizing 500 lbs. of portland cement and 88 lbs. of fly ash as a replacement of 88 lbs. of portland cement. The PCC mixture was utilized on the Muscatine County US 61 relocation bypass paved as project F-61-4(32)--20-70. A Class "C" fly ash obtained from the Chillicothe electric generating plant approximately 100 miles away was used in the project. This use of fly ash in lieu of portland cement resulted in a cost savings of $64,500 and an energy savings of approximately 16 billion BTU. The compressive strength of this PCC mixture option was very comparable to concrete mixtures produced without the use of fly ash. The pavement has been performing very well. The substitution of fly ash for 15% of the cement has been allowed as a contractor's option since 1984. Due to the cost savings, it has been used in almost all Iowa PCC paving since that time.

The development of automated methods for the determination of trace concentrations of carbomate pesticides in water using solid sorbent pre-concentration methods and high performance liquid chromatography /

Several automated reversed-phase HPLC methods have been developed to determine trace concentrations of carbamate pesticides (which are of concern in Ontario environmental samples) in water by utilizing two solid sorbent extraction techniques. One of the methods is known as on-line pre-concentration'. This technique involves passing 100 milliliters of sample water through a 3 cm pre-column, packed with 5 micron ODS sorbent, at flow rates varying from 5-10 mUmin. By the use of a valve apparatus, the HPLC system is then switched to a gradient mobile phase program consisting of acetonitrile and water. The analytes, Propoxur, Carbofuran, Carbaryl, Propham, Captan, Chloropropham, Barban, and Butylate, which are pre-concentrated on the pre-column, are eluted and separated on a 25 cm C-8 analytical column and determined by UV absorption at 220 nm. The total analytical time is 60 minutes, and the pre-column can be used repeatedly for the analysis of as many as thirty samples. The method is highly sensitive as 100 percent of the analytes present in the sample can be injected into the HPLC. No breakthrough of any of the analytes was observed and the minimum detectable concentrations range from 10 to 480 ng/L. The developed method is totally automated for the analysis of one sample. When the above mobile phase is modified with a buffer solution, Aminocarb, Benomyl, and its degradation product, MBC, can also be detected along with the above pesticides with baseline resolution for all of the analytes. The method can also be easily modified to determine Benomyl and MBC both as solute and as particulate matter. By using a commercially available solid phase extraction cartridge, in lieu of a pre-column, for the extraction and concentration of analytes, a completely automated method has been developed with the aid of the Waters Millilab Workstation. Sample water is loaded at 10 mL/min through a cartridge and the concentrated analytes are eluted from the sorbent with acetonitrile. The resulting eluate is blown-down under nitrogen, made up to volume with water, and injected into the HPLC. The total analytical time is 90 minutes. Fifty percent of the analytes present in the sample can be injected into the HPLC, and recoveries for the above eight pesticides ranged from 84 to 93 percent. The minimum detectable concentrations range from 20 to 960 ng/L. The developed method is totally automated for the analysis of up to thirty consecutive samples. The method has proven to be applicable to both purer water samples as well as untreated lake water samples.