bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster ‐ 50: The effect of metallic artifacts and their correction on CyberKnife skull and spine tracking
Authors: Sutherland Justin
Published: August 2016

Purpose:

CyberKnife tracking compares DRRs and periodic orthogonal x‐rays for patient localization, couch adjustments, and position adjustment of the linac head. Metallic artifacts in CT scans can potentially create discrepancies between DRRs and x‐rays. Additionally, suboptimal correction of artifacts may lead to inaccurate reconstruction of anatomy. This study investigates the effects that metallic artifacts and their correction have on CyberKnife skull and spine tracking.

Methods:

Skull tracking was tested with an anthropomorphic head‐neck phantom, using a Philips Brilliance Big Bore 16‐slice CT‐simulator with and without gold placed on the eye to simulate an external eyelid weight. Metallic artifacts in images with gold were corrected with orthopedic metal artifact reduction (O‐MAR). For each scan set, treatment plans were created and corrected couch positions for 10 phantom setups were recorded. To test spine tracking where bony anatomy is distorted due to O‐MAR for spinal screws, a spinous process was over‐ridden with a CT number of 55 HU. DRRs for this spine were compared with anatomically‐correct x‐rays to test for errors in spine matching.

Results:

Standard deviations in each direction and rotation for the no‐metal, metal, and metal with O‐MAR setups were comparable. Differences in average setup between the uncorrected and O‐MAR corrected plans were less than 0.8 times the no‐metal standard deviations. For the removed spinous process, the skeletal matching mesh indicated minimal error in anatomy: within daily patient variation.

Conclusions:

CyberKnife skull and spine tracking performed robustly against clinically realistic metallic artifacts and bony anatomy errors possibly introduced by O‐MAR.
Sci‐Fri AM: MRI and Diagnostic Imaging ‐ 01: Estimating the Transverse Relaxation Time of Taurine Protons in Rat Brain at 9.4 T with Optimized PRESS Sequence Timings
Authors: Fisher Marissa , Dobberthien Brennen , Tessier Anthony , Yahya Atiyah
Published: August 2016

Purpose:

To investigate the response of taurine (Tau) protons as a function of PRESS echo times, TE1 and TE2, to determine two TE combinations that can be employed to estimate the T2 (transverse relaxation) value of Tau at 9.4 T. The Tau protons are involved in J‐coupling interactions; therefore, the two timing combinations should result in similar signal losses due to J‐coupling.

Methods:

Experiments were performed with a 9.4 T animal MRI scanner. Numerical calculations of the response of Tau as a function of PRESS TE1 and TE2 were calculated and two TE combinations that yield a similar area for the 3.42 ppm Tau resonance were selected as optimal. The timings were verified on a 50 mM Tau/10 mM Cr (creatine) phantom. In‐vivo experiments were performed on four rats. Spectra were acquired with the timings from a voxel placed in the rat brain and Tau peak areas were fit to monoexponentially decaying functions to obtain T2 values.

Results:

The PRESS TE combinations selected for Tau T2 determination are {TE1, TE2} = {17 ms, 10 ms} and {80 ms, 70 ms}; the signal yield for the two timings differs by 5 % theoretically. The average Tau T2 for the four rats was found to be 106 ms with a standard deviation of 12 ms.

Conclusions:

We have demonstrated that acquiring PRESS spectra with {TE1, TE2} = {17 ms, 10 ms} and {TE1, TE2} = {80 ms, 70 ms} enables T2 corrected measures of Tau to be obtained at 9.4 T.
Sci‐Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment
Authors: Montgomery Logan , Kildea John
Published: August 2016

We report on the development and clinical deployment of an in‐house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR‐RT). In producing our new system, we aimed to:

Analyze actual incidents, as well as potentially dangerous latent conditions.

Produce recommendations on the NSIR‐RT taxonomy.

Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR‐RT framework.

Share anonymized incident data with the national database.

Our multistep incident reporting workflow is focused around an initial report and a detailed follow‐up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff.

Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near‐misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself.

Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.
Sci‐Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques ‐ 01: On the use of proton radiography to reduce beam range uncertainties and improve patient positioning accuracy in proton therapy
Authors: Collins‐Fekete Charles‐Antoine , Beaulieu Luc , Seco Joao
Published: August 2016

To present two related developments of proton radiography (pRad) to minimize range uncertainty in proton therapy. The first combines a pRad with an X‐ray CT to produce a patient‐specific relative stopping power (RSP) map. The second aims to improve the pRad spatial resolution for accurate registration prior to the first. The enhanced‐pRad can also be used in a novel proton‐CT reconstruction algorithm.

Monte Carlo pRad were computed from three phantoms; the Gammex, the Catphan and an anthropomorphic head. An optimized cubic‐spline estimator derives the most likely path. The length crossed by the protons voxel‐by‐voxel was calculated by combining their estimated paths with the CT. The difference between the theoretical (length×RSP) and measured energy loss was minimized through a least squares optimization (LSO) algorithm yielding the RSP map. To increase pRad spatial resolution for registration with the CT, the phantom was discretized into voxels columns. The average column RSP was optimized to maximize the proton energy loss likelihood (MLE).

Simulations showed precise RSP (<0.75%) for Gammex materials except low‐density lung (<1.2%). For the head, accurate RSP were obtained (µ=−0.10%1.5σ=1.12%) and the range precision was improved (ΔR80 of −0.20±0.35%). Spatial resolution was increased in pRad (2.75 to 6.71 lp/cm) and pCT from MLE‐enhanced pRad (2.83 to 5.86 lp/cm).

The LSO decreases the range uncertainty (R80σ<1.0%) while the MLE‐enhanced pRad spatial resolution (+244%) and is a great candidate for pCT reconstruction.
Sci‐Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques ‐ 09: Impact of the distance of reflective markers from linac isocenter on the positional accuracy of an infrared tracking system
Authors: Ali Elsayed , Nyiri Balazs
Published: August 2016

Purpose:

The HexaPOD™ six degree of freedom couchtop is equipped with an optical tracking system, consisting of a stereoscopic camera and a reference frame (RF) carrying infrared reflective markers. The manufacturer recommends placing the RF within 50 cm from linac isocenter (ISO), which is a serious limitation since the RF does not fit around the shoulders of most brain patients. This study quantifies the impact of extended RF distances from ISO on positional accuracy.

Methods:

An in‐house tool with an estimated resolution of 0.3 mm and 0.1° was used. It is a large cube and a mathematical model of HexaPOD motion to determine the intersection of room lasers with the ruled cube edges. Combinations of translations (±1 and ±3 cm) and rotations (±2.5°) were executed on two HexaPOD couchtops for multiple RF distances from ISO (35 to 77 cm). For each combination, ten laser readings were fed into a least squares algorithm to determine the executed translations and rotations while minimizing operator reading errors.

Results:

The usable tracking volume is up to an RF distance of 82 cm from ISO. Positional accuracy of the HexaPOD/iGuide system is 0.6 mm and 0.1° (95% confidence). Positional accuracy variations versus RF distance from ISO are statistically insignificant (p = 0.05). Our results generally confirm recent internal estimates by the manufacturer (for future release).

Conclusions:

RF distances up to 77 cm from ISO are clinically acceptable, provided performing a patient safety study with a verification scan.
The Law of Entropy Increase – A Lab Experiment
Authors: Dittrich William , Drosd Robert , Minkin Leonid , Shapovalov Alexander S.
Published: August 2016

The second law of thermodynamics has various formulations. There is the “Clausius formulation,” which can be stated in a very intuitive way: “No process is possible whose sole result is the transfer of heat from a cooler to a hotter body.” There is also the “Kelvin-Plank principle,” which states that “no cyclic process exists whose sole result is the absorption of heat from a reservoir and the conversion of all this heat into work” [emphasis added] (since this would require perfect energy conversion efficiency). Both these statements can be presented to physics students in a conceptual manner, and students’ “everyday” experiences will support either statement of the second law of thermodynamics. However, when the second law of thermodynamics is expressed using the concept of entropy (ΔS ≥ 0, for a closed system), most first-year physics students lack any direct experimental experience with this parameter. This paper describes a calculation of the increase in entropy that can be performed while completing three traditional thermodynamics experiments. These simple and quick calculations help students become familiar and comfortable with the concept of entropy. This paper is complementary to prior work where classroom activities were developed to provide insight into the statistical nature of entropy.
Human recognition of familiar voices
Authors: Wenndt Stanley J.
Published: August 2016

Recognizing familiar voices is something we do every day. In quiet environments, it is usually easy to recognize a familiar voice. In noisier environments, this can become a difficult task. This paper examines how robust listeners are at identifying familiar voices in noisy, changing environments and what factors may affect their recognition rates. While there is previous research addressing familiar speaker recognition, the research is limited due to the difficulty in obtaining appropriate data that eliminates speaker dependent traits, such as word choice, along with having corresponding listeners who are familiar with the speakers. The data used in this study were collected in such a fashion to mimic conversational, free-flow dialogue, but in a way to eliminate many variables such as word choice, intonation, or non-verbal cues. These data provide some of the most realistic test scenarios to-date for familiar speaker identification. A pure-tone hearing test was used to separate listeners into normal hearing and hearing impaired groups. It is hypothesized that the results of the Normal Hearing Group will be statistically better. Additionally, the aspect of familiar speaker recognition is addressed by having each listener rate his or her familiarity with each speaker. Two statistical approaches showed that the more familiar a listener is with a speaker, the more likely the listener will recognize the speaker.
A blind deconvolution method for attenuative materials based on asymmetrical Gaussian model
Authors: Jin Haoran , Chen Jian , Yang Keji
Published: August 2016

During propagation in attenuative materials, ultrasonic waves are distorted by frequency-dependent acoustic attenuation. As a result, reference signals for blind deconvolution in attenuative materials are asymmetrical and should be accurately estimated by considering attenuation. In this study, an asymmetrical Gaussian model is established to estimate the reference signals from these materials, and a blind deconvolution method based on this model is proposed. Based on the symmetrical Gaussian model, the asymmetrical one is formulated by adding an asymmetrical coefficient. Upon establishing the model, the reference signal for blind deconvolution is determined via maximum likelihood estimation, and the blind deconvolution is implemented with an orthogonal matching pursuit algorithm. To verify the feasibility of the established model, spectra of ultrasonic signals from attenuative polyethylene plates with different thicknesses are measured and estimated. The proposed blind deconvolution method is applied to the A-scan signal and B-scan image from attenuative materials. Results demonstrate that the proposed method is capable of separating overlapping echoes and therefore achieves a high temporal resolution.
Latin American Physical Educators’ Intention to Teach Individuals With Disabilities
Authors: Columna Luis , Hoyos-Cuartas Luz Amelia , Foley John T. , Prado-Perez Jose Rafael , Chavarro-Bermeo Dana Milena , Mora Ana Lorena , Ozols-Rosales Maria Antonieta , Cid Luis Álvarez-del , Rivero Ivana
Published: August 2016

Purpose:

To analyze Latin American physical education (PE) teachers’ intentions toward teaching students with disabilities.

Participants:

474 in-service PE teachers from 5 different Latin American countries.

Method:

Descriptive survey. Data were collected using a modified version of the Physical Educators’ Intention Toward Teaching Individuals With Disabilities Survey. Multiple-regression analysis showed significant differences in the attitudes of teachers by gender, the number of adapted-PE courses taken, and years of experience working with individuals with disabilities.

Results:

The predictor variables had a significant impact on the participants’ intentions toward teaching children with disabilities; however, the effects of these predictor variables differed between countries.
The Effects of Acute Intense Physical Exercise on Postural Stability in Children With Cerebral Palsy
Authors: Leineweber Matthew J. , Wyss Dominik , Dufour Sophie-Krystale , Gane Claire , Zabjek Karl , Bouyer Laurent J. , Maltais Désirée B. , Voisin Julien I.A. , Andrysek Jan
Published: August 2016

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.
Approaching the ideal elastic strain limit in silicon nanowires
Authors: Zhang Hongti , Tersoff Jerry , Xu Shang , Chen Huixin , Zhang Qiaobao , Zhang Kaili , Yang Yong , Lee Chun-Sing , Tu King-Ning , Li Ju , Lu Yang
Published: August 2016

Single-crystalline silicon nanowires can be reversibly stretched above 10% elastic strain at room temperature.
A simple high-performance matrix-free biomass molten carbonate fuel cell without CO
2
recirculation
Authors: Lan Rong , Tao Shanwen
Published: August 2016

A matrix-free molten carbonate fuel cell without CO
2
recirculation for efficient power generation from carbon-containing fuels.
Animal-based studies will be essential for precision medicine
Authors: Kent Lloyd K. C. , Robinson Peter N. , MacRae Calum A.
Published: August 2016

Precision medicine will be advanced by systematically integrating animal models of human disease, computational frameworks, and experimental preclinical strategies for validation of clinically actionable findings.
Gut check
Authors: Greene Casey S.
Published: August 2016

A new analysis asks which microbiome signatures work across studies.
Comparative Performance of Reagents and Platforms for Quantitation of Cytomegalovirus DNA by Digital PCR
Authors: Hayden R. T. , Gu Z. , Sam S. S. , Sun Y. , Tang L. , Pounds S. , Caliendo A. M.
Published: August 2016

A potential benefit of digital PCR is a reduction in result variability across assays and platforms. Three sets of PCR reagents were tested on two digital PCR systems (Bio-Rad and RainDance), using three different sets of PCR reagents for quantitation of cytomegalovirus (CMV). Both commercial quantitative viral standards and 16 patient samples (
n
= 16) were tested. Quantitative accuracy (compared to nominal values) and variability were determined based on viral standard testing results. Quantitative correlation and variability were assessed with pairwise comparisons across all reagent-platform combinations for clinical plasma sample results. The three reagent sets, when used to assay quantitative standards on the Bio-Rad system, all showed a high degree of accuracy, low variability, and close agreement with one another. When used on the RainDance system, one of the three reagent sets appeared to have a much better correlation to nominal values than did the other two. Quantitative results for patient samples showed good correlation in most pairwise comparisons, with some showing poorer correlations when testing samples with low viral loads. Digital PCR is a robust method for measuring CMV viral load. Some degree of result variation may be seen, depending on platform and reagents used; this variation appears to be greater in samples with low viral load values.
First terrestrial occurrence of tistarite (Ti2O3): Ultra-low oxygen fugacity in the upper mantle beneath Mount Carmel, Israel
Authors: Griffin W.L. , Gain S.E.M. , Adams D.T. , Huang J-X. , Saunders M. , Toledo V. , Pearson N.J. , O’Reilly S.Y.
Published: August 2016

The minimum oxygen fugacity (fO2) of Earth’s upper mantle probably is controlled by metal saturation, as defined by the iron-wüstite (IW) buffer reaction (FeO → Fe + O). However, the widespread occurrence of moissanite (SiC) in kimberlites, and a suite of super-reduced minerals (SiC, alloys, native elements) in peridotites in Tibet and the Polar Urals (Russia), suggest that more reducing conditions (fO2 = 6–8 log units below IW) must occur locally in the mantle. We describe pockets of melt trapped in aggregates of corundum crystals ejected from Cretaceous volcanoes in northern Israel which contain high-temperature mineral assemblages requiring extremely low fO2 (IW < −10). One abundant phase is tistarite (Ti2O3), previously known as a single grain in the Allende carbonaceous chondrite (Mexico) and believed to have formed during the early evolution of the solar nebula. It is associated with other reduced phases usually found in meteorites. The development of super-reducing conditions in Earth’s upper mantle may reflect the introduction of CH4 + H2 fluids from the deep mantle, specifically related to deep-seated volcanic plumbing systems at plate boundaries.
Electroacupuncture Restores Spatial Learning and Downregulates Phosphorylated N-Methyl-D-Aspartate Receptors in a Mouse Model of Parkinson's Disease
Authors: Lu Kung-Wen , Yang Jun , Hsieh Ching-Liang , Hsu Yu-Chan , Lin Yi-Wen
Published: August 2016

Objective

Parkinson's disease (PD) is a degenerative disorder of the central nervous system. PD can be classified as idiopathic, acquired or hereditary and may be caused by various factors such as oxidative stress, loss of mitochondrial function, neuronal excitotoxicity or calcium imbalance.

Methods

We hypothesised that electroacupuncture (EA) at KI3 would reduce neuronal excitotoxicity by regulating N-methyl-D-aspartate (NMDA) receptor function and may represent a novel therapeutic approach for PD.

Results

Our results showed that deficits in spatial learning (reflected by the escape latency time in the Morris water maze task) and long-term potentiation (LTP) caused by systemic 6-hydroxydopamine (6-OHDA) administration (that damages dopaminergic neurons) could be rescued by EA on day 3. In PD mice, phosphorylated NMDA receptor subunits NR1 and NR2B were elevated (134.03±10.17% and 123.46±3.47% of baseline levels, respectively) but total NR1 and NR2B was unaffected (101.37±3.87% and 102.61±4.22% of baseline, respectively). Elevated levels of pNR1 and pNR2B, and phosphorylated forms of protein kinase A, protein kinase C, α Ca2+/calmodulin-dependent protein kinase extracellular signal-regulated kinases (pERK), and cAMP response element-binding protein were also reduced following EA.

Conclusions

These novel findings suggest that EA can rescue learning and LTP deficits in a rodent model of PD. The results point to a possible role for EA-based approaches in the clinical treatment of learning deficits associated with PD.
Assessment of Reporting Quality in Randomised Controlled Trials of Acupuncture for Post-Stroke Rehabilitation Using the Consort Statement and Stricta Guidelines
Authors: Zeng Jingchun , Lin Guohua , Li Lixia , Lu Liming , Chen Chuyun , Lu Lihong
Published: August 2016

Objectives

To evaluate the completeness of reporting of randomised controlled trials (RCTs) of acupuncture for post-stroke rehabilitation in order to provide information to facilitate transparent and more complete reporting of acupuncture RCTs in this field.

Methods

Multiple databases were searched from their inception through September 2015. Quality of reporting for included papers was assessed against a subset of criteria adapted from the Consolidated Standards for Reporting Trials (CONSORT) 2010 statement and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) guidelines. Each item was scored 1 if it was reported, or 0 if it was not clearly stated. Descriptive statistical analysis was performed. Cohen's κ-statistics were calculated to assess agreement between the two reviewers.

Results

A total of 87 RCTs were included in the full text. Based on CONSORT, good reporting was evident for items “Randomised’ in the title or abstract’, ‘Participants’, ‘Statistical methods’, ‘Recruitment’, ‘Baseline data’, and ‘Outcomes and estimation’, with positive rates >80%. However, the quality of reporting for the items ‘Trial design’, ‘Outcomes’, ‘Sample size’, ‘Allocation concealment’, ‘Implementation’, ‘Blinding’, ‘Flow chart’, ‘Intent-to-treat analysis’, and ‘Ancillary analyses’ was very poor with positive rates <10%. Based on STRICTA, the items ‘Number of needle insertions per subject per session’, ‘Responses sought’, and ‘Needle type’ had poor reporting with positive rates <50%. Substantial agreement was observed for most items and good agreement was observed for some items.

Conclusions

The reporting quality of RCTs in acupuncture for post-stroke rehabilitation is unsatisfactory and needs improvement.
Modifying the infant's diet to prevent food allergy
Authors: Grimshaw Kate , Logan Kirsty , O'Donovan Sinead , Kiely Mairead , Patient Karine , van Bilsen Jolanda , Beyer Kirsten , Campbell Dianne E , Garcia-Larsen Vanessa , Grabenhenrich Linus , Lack Gideon , Mills Clare , Wal Jean-Michel , Roberts Graham
Published: August 2016

Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals. The review was undertaken as part of the European Union funded Integrated Approaches to Food Allergy and Allergen Management (iFAAM) study. This is a wide ranging project bringing together expertise across the breadth of food allergy research. Specifically, the review discusses dietary manipulation in food allergy prevention, and covers the possible preventive strategies of allergen avoidance, early allergen introduction, general nutrition and supplements, as well as other strategies, such as prebiotics and probiotics. The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4–6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic.
EFFECT OF PASTEURISATION ON THE CONCENTRATIONS OF VITAMIN D COMPOUNDS IN DONOR BREAST MILK
Authors: Gomes Fabio , Shaw Nick , Whitfield Karen , Koorts Pieter , McConachy Helen , Hewavitharana Amitha
Published: August 2016

Aim

Breastmilk is considered the most important nutrient and source of supplementation for both term and preterm infants.1 It is composed of many important nutrients, including vitamin D.2 The content of this vitamin in breast milk is usually low, even for lactating mothers with adequate vitamin D status.2 3 Preterm infants are at the great risk of vitamin D deficiency due to decreased transplacental transfer.4 Premature infants are the main recipients of pasteurised donor human milk (PDHM), when their mothers are unable to provide their own.

This study aims to evaluate the effect of pasteurisation on the concentrations of vitamin D compounds in donor breast milk.

Method

A total of 16 participants, who donated breast milk to the RBWH milk bank, were recruited in this study. Milk samples were obtained pre- and post-Holder pasteurisation. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was used to analyse the samples for vitamins D2 and D3 and 25-hydroxyvitamins D2 and D3 (25(OH)D2 and 25(OH)D3). The significance of differences in vitamin D concentrations between the two groups of milk samples was assessed using the Wilcoxon matched-pairs signed rank test, in which P<0.05 was considered significant.

Results

Pasteurisation resulted in a significant reduction (P<0.05) in the content of D2, D3, 25(OH)D2 and 25(OH)D3, with P values of 0.0001 for all targeted analytes. The concentrations of the vitamin D analogues in non-pasteurised milk ranged from 3.6 to 5.0 pM (D2), 1.0 to 9.8 pM (D3), 1.4 to 2.1 pM (25(OH)D2) and 1.2 to 9.3 pM (25(OH)D3). The concentrations of the vitamin D analogues in post-pasteurised milk ranged from 3.0 to 4.0 pM (D2), 0.6 to 9.5 pM (D3), 1.2 to 1.7 pM (25(OH)D2) and 1.1 to 9.1 pM (25(OH)D3). Losses of vitamin D compounds resulting from the pasteurisation process ranged from 10% to 20%.

Conclusion

Pasteurisation significantly affected the concentration of vitamin D compounds in pasteurised donor breast milk.
WHAT IS THE MAXIMUM TEMPERATURE REACHED IN ELASTOMERIC DEVICES UNDER SIMULATED OPAT CONDITIONS?
Authors: Merwe Susanna van Der , Green Helen
Published: August 2016

Aim

Outpatient parenteral antimicrobial therapy (OPAT), both in children and adults, is increasing in use as part of a cost saving measure for the NHS.1 However there is a general lack of stability data for antibiotics in elastomeric devices. The ‘Yellow Covered Document’2 (YCD), as it is commonly known, specifies the storage conditions, under which stability testing should be carried out ranging from freezing to a worst case scenario of 37°C±2°C. It is assumed that a temperature of 37°C equates to wearing a device reservoir under clothing close to the body e.g. under a winter coat, however evidence supporting this assumption is lacking. The main aim of the study was to determine how warm the solution in an elastomeric device becomes under various simulated conditions to inform future stability studies.

Method

The study was conducted during the winter months. Miniature Type K Thermocouples, were inserted into 2 types of elastomeric devices: 240 ml Baxter Infusor LV 10 (BI) and 120 ml I-Flow Homepump Eclipse® C-Series (IFHE). The elastomeric devices were filled with sterile water to simulate the drug solution. Temperature data was collected from devices stored for 24 hrs in a fridge followed by a 24 hour period at ambient temperature, simulating patients going about their daily lives including wearing devices under clothing when it was cold.

Results

The water in the BI took 4 hrs 0 min to decrease from 20°C (ambient temperature on the day) to 5°C when refrigerated, compared to 1 hr 22 min for the IFHE. After removal from the fridge the BI took an average of 6 hrs 12 min to reach 20°C compared to 2 hrs 28 min for the IFHE. The average maximum temperature if worn normally, therefore not under any clothing, was 23.3±0.8°C in the BI and 23.8±0.6°C in the IFHE. When worn under clothing the maximum temperature reached in the BI was 28.1°C and in the IFHE 23.4°C.

Conclusion

Since it is well known that an increase in temperature leads to an increase in drug degradation,3 the results of this study justifies stability testing in elastomeric devices at a more realistic temperature, preventing antibiotics and other drugs potentially being excluded from outpatient parenteral administration. A temperature of 30°C is suggested allowing for slight body temperature variation between patients as well as allowing for warmer days during summer in the UK. It is hypothesised that the delay in temperature change observed for the BI is due to the protective casing around the balloon, acting as an insulator to the environment.
A REALLY WHEEZY WAY TO SAVE MONEY
Authors: Li Grace , Almossawi Ofran , Dulfeker Hasna , Jones Vicky , Taylor Felicity
Published: August 2016

Aim

To compare the palatability of oral non-soluble and oral soluble prednisolone tablets in paediatric patients admitted to the general paediatric wards in an acute London Trust.

Method

As part of ongoing quality improvement initiatives, the Paediatric and Pharmacy departments compared tolerability of soluble versus non-soluble prednisolone in a group of 27 patients. Using a modified 5 point hedonic scale with ‘smiley’ faces we measured palatability and tolerance (swallowed versus refusal or vomiting) over two three week periods: the first period whilst soluble prednisolone was dispensed (n=17) and the second period after the switch to non-soluble prednisolone had been made (n=10). All data were collected by doctors and nurses on the two paediatrics wards.

Results

We found acceptance of prednisolone to be similar before and after formulations were switched: 2 non-tolerated doses before (n=17) versus 3 non-tolerated doses after the switch (n=10).

We found that ‘disguising’ the taste of the non-soluble prednisolone within a portion of sugar free jam, or mixed with 5 ml of sugar-free blackcurrant cordial, helped with acceptance, although both soluble and non-soluble formulations were frequently reported to be “Yuk”!

Conclusions

The Trust has since made the switch to non-soluble prednisolone for all paediatric inpatients and for take home medications. An information leaflet has been developed for parents or carers to understand how to crush the prednisolone tablets. We have not had any parent or carer reported difficulty in preparing or administering the medication.

Children under 15 account for 37.8% (20,510 of 54,300) of annual hospital admissions for acute asthma.1 A minimum course of 3 days' oral steroids are recommended in the BTS/SIGN 2014 guideline on the management of asthma.2 This acute Trust covers a population of over 300,000 in deprived boroughs of London.

A typical three-day course of soluble prednisolone (at 2 mg/kg as per guidance, or approximately 20 mg) costs £20.88, compared to £2.48 for the equivalent dose of non-soluble prednisolone dispensed with a tablet crusher. Several hospital trusts have switched to using non-soluble prednisolone in order to achieve cost savings, but there have been anecdotal reports of poor palatability, raising concerns about compliance with taking medication once discharged.

The switch from a soluble to a non-soluble formulation of prednisolone represents an annual saving of more than £44,000 for this hospital alone and, at scale, could realise substantial potential savings to the NHS, without compromising patients' clinical care.
PRESCRIBING AND MONITORING OF GENTAMICIN IN NEONATES
Authors: Staton Nicola
Published: August 2016

Aim

To evaluate the implementation of the National Institute for Health and Care Excellence (NICE) clinical guideline1 with regards to the prescribing, exposure and therapeutic drug level monitoring of gentamicin in early onset neonatal infection.

Method

A selection of drug charts for babies who were prescribed gentamicin within 72 hrs of birth were reviewed. The number of doses of gentamicin administered, C-reactive protein (CRP) results, blood culture results and gentamicin trough levels were recorded. A new gentamicin prescription chart was developed based on the NICE clinical guideline1 and the National Patient Safety Agency (NPSA) alert2 on the safer use of gentamicin for neonates, and was launched on the Neonatal Intensive Care Unit (NICU). A number of months after the new gentamicin prescription chart was introduced, and had therefore had time to become embedded into practice, a selection of babies' drug charts were reviewed and the same information as previously was documented. The information obtained before and after the introduction of the new gentamicin prescription chart was compared.

Results

Prior to the new gentamicin prescription chart 16 prescriptions for gentamicin were reviewed, and in total 47 doses of gentamicin were administered. Blood cultures were negative after five days in all 16 patients. In total 9 gentamicin trough levels were taken with only one level being >2 mg/L. Following the introduction of the new prescription chart another 16 prescriptions for gentamicin were reviewed, and in total 38 doses of gentamicin were administered. Again blood cultures were negative after five days in all 16 patients. In total 14 gentamicin trough levels were taken with two levels being >2 mg/L. Prior to the new gentamicin prescription chart 50% of babies received more than one dose of gentamicin despite having two CRP results <10. This is compared to 31% of babies following the introduction of the new gentamicin prescription chart.

Conclusion

It can be concluded that the new gentamicin prescription chart has resulted in a reduction in the exposure of babies to gentamicin, as all babies now have it administered at 36 hourly intervals. There has also been an increase in blood monitoring of trough gentamicin levels, as they are now taken prior to the second dose rather than the third dose. Therefore the new gentamicin prescription chart is safer as toxic levels are identified sooner, which reduces the risk of babies suffering adverse effects.

Since the introduction of the new gentamicin prescription chart 31% of babies received more than the necessary number of gentamicin doses, as dictated by the CRP results and blood culture result at 36 hrs. This is a learning point which will be highlighted to the medical and nursing staff on NICU.
HELLP syndrome: a diagnostic conundrum with severe complications
Authors: Rao Devika , Chaudhari Nikulkumar Kumar , Moore Robert Michael , Jim Belinda
Published: August 2016

The HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome is believed to be part of the spectrum of pre-eclampsia, which falls within the category of hypertensive disorders of pregnancy. Maternal and fetal complications are more severe in HELLP as opposed to pre-eclampsia alone. We describe a 26-year-old primigravida woman with no medical history who presents with signs of HELLP with marked transaminitis and mild disseminated intravascular coagulation at 35 weeks of gestation who required emergent delivery of the fetus; the patient also sustained acute kidney injury requiring continuous veno-venous hemodiafiltration and a prolonged intensive care unit admission. Remarkably, with supportive care, all laboratory derangements, including renal function, normalised after 4 weeks. We discuss the diagnostic conundrum when faced with the possible diagnosis of HELLP in discriminating from its many imitators in order to assume proper treatment.
Axillary artery pseudoaneurysm resulting in brachial plexus injury in a patient taking new oral anticoagulants
Authors: Monem Mohammed , Iskandarani Mohamad Khalid , Gokaraju Kishan
Published: August 2016

We discuss the case of an independent 80-year-old Caucasian woman, being treated with new oral anticoagulants for a previous deep vein thrombosis, who had fallen on her right shoulder. She made a delayed presentation to the emergency department with a wrist drop in her right dominant hand. She had right arm bruising with good distal pulses but had a global neurological deficit in the hand. Plain radiographs of the shoulder, humerus, elbow, forearm and wrist demonstrated no fractures. MRI showed a significant right axillary lesion distorting the surrounding soft tissues, including the brachial plexus, and CT with contrast confirmed this to be a large axillary pseudoaneurysm. This was treated with an endovascular stent resulting in slightly improved motor function, but the significant residual deficit required subsequent rehabilitation to improve right upper limb function.
How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness
Authors: Schwellnus Martin , Soligard Torbjørn , Alonso Juan-Manuel , Bahr Roald , Clarsen Ben , Dijkstra H Paul , Gabbett Tim J , Gleeson Michael , Hägglund Martin , Hutchinson Mark R , Janse Van Rensburg Christa , Meeusen Romain , Orchard John W , Pluim Babette M , Raftery Martin , Budgett Richard , Engebretsen Lars
Published: August 2016

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load—including rapid changes in training and competition load, competition calendar congestion, psychological load and travel—and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.
How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury
Authors: Soligard Torbjørn , Schwellnus Martin , Alonso Juan-Manuel , Bahr Roald , Clarsen Ben , Dijkstra H Paul , Gabbett Tim , Gleeson Michael , Hägglund Martin , Hutchinson Mark R , Janse van Rensburg Christa , Khan Karim M , Meeusen Romain , Orchard John W , Pluim Babette M , Raftery Martin , Budgett Richard , Engebretsen Lars
Published: August 2016

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.
Associations of neonatal high birth weight with maternal pre-pregnancy body mass index and gestational weight gain: a case–control study in women from Chongqing, China
Authors: Xie Yao Jie , Peng Rong , Han Lingli , Zhou Xiaoli , Xiong Zhengai , Zhang Yuan , Li Junnan , Yao Ruoxue , Li Tingyu , Zhao Yong
Published: August 2016

Objectives

To examine the associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with neonatal high birth weight (HBW) in a sample of Chinese women living in southwest China.

Methods

A hospital-based case–control study was conducted in Chongqing, China. A total of 221 mothers who delivered HBW babies (>4.0 kg) were recruited as cases and 221 age-matched (2-year interval) mothers with normal birth weight babies (2.5–4.0 kg) were identified as controls. ORs were estimated using conditional logistic regression analysis. For the analysis, pre-pregnancy BMI was categorised as underweight/normal weight/overweight and obesity and GWG was categorised as inadequate/appropriate/excessive.

Results

Among the cases, mean pre-pregnancy BMI was 21.8±2.8 kg/m2, mean GWG was 19.7±5.1 kg and mean neonatal birth weight was 4.2±0.2 kg. In the controls, the corresponding values were 21.1±3.1 kg/m2, 16.4±5.0 kg and 3.3±0.4 kg, respectively. More cases than controls gained excessive weight during pregnancy (80.1% vs 48.4%, p<0.001). No significant association was found between pre-pregnancy BMI and HBW babies (OR=1.04, 95% CI 0.97 to 1.11; p>0.05). GWG was positively related to HBW after adjustment for gravidity, gestational age, newborns' gender and family income (OR=1.18, 95% CI 1.12 to 1.25; p<0.001). The adjusted OR of delivering HBW babies was 5.39 (95% CI 2.94 to 9.89; p<0.001) for excessive GWG versus appropriate GWG. This OR was strengthened among pre-pregnancy normal weight women (OR=10.27, 95% CI 3.20 to 32.95; p<0.001).

Conclusions

Overall, the findings suggest a significantly positive association between GWG and HBW. However, pre-pregnancy BMI shows no independent relationship with HBW.
Interprofessional education in the care of people diagnosed with dementia and their carers: a systematic review
Authors: Jackson Marcus , Pelone Ferruccio , Reeves Scott , Hassenkamp Anne Marie , Emery Claire , Titmarsh Kumud , Greenwood Nan
Published: August 2016

Objectives

This systematic review is linked to the multifaceted social, economic and personal challenges of dementia and the international recognition of the value of interprofessional education (IPE) and its influence on health and social care outcomes. This review therefore aimed to identify, describe and evaluate the impact of IPE interventions on health and social care practitioners (prequalification and postqualification) understanding of dementia, the quality of care for people with dementia and support for their carers.

Methods

Following PRISMA guidelines, 9 databases were searched (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, CINAHL Plus, Applied Social Sciences Index and Abstracts, Healthcare Management Information Consortium, ERIC and British Education Index). Narrative analysis of the findings was undertaken.

Design

Systematic review.

Results

6 studies meeting the inclusion criteria were identified. The majority of studies were conducted in North America. Participants in 4 studies were health and social care practitioners caring for people with dementia, whereas the remaining studies focused on training graduate or undergraduate students. Diverse IPE activities with varying content, delivery mode and duration were reported. Although some studies reported more positive attitudes to interprofessional working as a result of the interventions, none reported benefits to patients or carers. The quality of the included studies varied. Overall, the evidence for the reported outcomes was considered weak.

Conclusions

This review identified 6 studies describing IPE interventions intended to improve collaborative knowledge, skills, interprofessional practice and organisational awareness of dementia and dementia care. The small number of studies, their varied nature, scope and settings combined with poor quality of evidence limits our understanding of the effectiveness of IPE on the care and support of people with dementia and their carers. Further research is required to develop the evidence base and provide robust studies to inform IPE development.

Trial registration number

CRD42014015075.
Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study
Authors: Caperchione Cristina M , Sabiston Catherine M , Clark Marianne I , Bottorff Joan L , Toxopeus Renee , Campbell Kristin L , Eves Neil D , Ellard Susan L , Gotay Carolyn
Published: August 2016

Introduction

Physical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE.

Method and analysis

A quasi-experimental pre–post design will be used. Twelve groups of 8–12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year.

Ethics and dissemination

Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.