bluuebunny/crossref_metadata_2025 huggingface dataset:
A cascade dead-zone extended state observer for a class of systems with measurement noise
Authors: Zhang Shihua , Qi Xiaohui , Yang Sen
Published: April 2023

For high frequency noise, a new $ 2n $-th order cascade extended state observer with dynamic dead-zone structure is proposed in this paper. Dead zone dynamic consists of two parts. One is to "trim" the effect of noise by cutting off the part that falls in the dead zone. The other part pushes the dead zone amplitude to converge to 0 as soon as possible to ensure the convergence of the estimation error. Moreover, in the cascade structure, the high-gain parameter grows only to a second power, thus avoiding excessive amplification of the measurement noise and solving numerical implementation problems. The design procedure ensures that the extended state observer is input-to-state stable. Numerical simulations show the improvement in terms of total disturbance estimation and noise attenuation. The frequency-domain analysis of the proposed ESO using the describing function method investigates the effect of the dead zone nonlinear parameter on the performance of a closed-loop system.
Wavelet estimations of the derivatives of variance function in heteroscedastic model
Authors: Kou Junke , Zhang Hao
Published: April 2023

This paper studies nonparametric estimations of the derivatives $ r^{(m)}(x) $ of the variance function in a heteroscedastic model. Using a wavelet method, a linear estimator and an adaptive nonlinear estimator are constructed. The convergence rates under $ L^{\tilde{p}} (1\leq \tilde{p} < \infty) $ risk of those two wavelet estimators are considered with some mild assumptions. A simulation study is presented to validate the performances of the wavelet estimators.
A lightweight dual-path cascaded network for vessel segmentation in fundus image
Authors: Sun Yanxia , Li Xiang , Liu Yuechang , Yuan Zhongzheng , Wang Jinke , Shi Changfa
Published: April 2023

Automatic and fast segmentation of retinal vessels in fundus images is a prerequisite in clinical ophthalmic diseases; however, the high model complexity and low segmentation accuracy still limit its application. This paper proposes a lightweight dual-path cascaded network (LDPC-Net) for automatic and fast vessel segmentation. We designed a dual-path cascaded network via two U-shaped structures. Firstly, we employed a structured discarding (SD) convolution module to alleviate the over-fitting problem in both codec parts. Secondly, we introduced the depthwise separable convolution (DSC) technique to reduce the parameter amount of the model. Thirdly, a residual atrous spatial pyramid pooling (ResASPP) model is constructed in the connection layer to aggregate multi-scale information effectively. Finally, we performed comparative experiments on three public datasets. Experimental results show that the proposed method achieved superior performance on the accuracy, connectivity, and parameter quantity, thus proving that it can be a promising lightweight assisted tool for ophthalmic diseases.
Sustainable Growth Strategies for Entrepreneurial Tourism
Authors: Sharma Eliza
Published: April 2023

The present study seeks to develop a model that can establish a structural association between development of entrepreneurial tourism, and development of socially-backward communities as well. Keeping in view the promising growth of the tourism sector, and huge opportunities for the entrepreneurs in this sector, this current study will aim to answer the followings research questions: RQ1: What can be the different sustainable growth strategies for the entrepreneurial tourism? RQ2: How different stakeholders can be involved for the sustainable growth of tourism sector? RQ3: How growth of entrepreneurial tourism can be linked to regional development?
Digital Protection of Traditional Villages for Sustainable Heritage Tourism
Authors: Zuo Yixin , Lam Apple Hiu Ching , Chiu Dickson K. W.
Published: April 2023

Similar to the plight of other traditional villages, Qiqiao Ancient Village is declining under the impact of urbanization and the devastation of modernization. Qiqiao is chosen as the case study as it is the second-largest settlement of Confucian descendants, with a rich cultural heritage. In recent years, the local government has taken measures such as cultural heritage restoration and tourism development to protect their traditional village, but the result is unsatisfactory. By field observation and interviewing three groups of stakeholders, the protection project manager, villagers, and tourists, this research analyzed the current situation of Qiqiao and digital protection applications for its heritage tourism to reveal some recent problems. Considering the local economic and technological conditions, this research suggested digital solutions for similar traditional villages in protection projects for sustainable heritage tourism.
Reconstructing Mental Models for Favorable Perceptions
Authors: Ponciano Leslie
Published: April 2023

This chapter begins with an exploration of important terms, processes, and theories that contribute to an understanding of the roles that perception, mental models, media consumption, experts, and language play in the development of favorable or unfavorable biases over time. These constructs are synthesized into a simple theoretical model for reconstructing mental models. This is followed by transformations in public opinion over the past few decades that are linked to changes in mental models.
Communicating Sustainability to Wine Tourists, the Next “Big Thing” for the Landmark Wineries
Authors: Cejudo Adela Balderas , Aldama Izaskun Zurbitu , Sanchez Anais Iglesias
Published: April 2023

Sustainability is becoming vital for all wineries to respond to consumers' concerns and meet their requirements, especially for younger generations. Wineries are constantly engaged in more sustainable practices regarding viticulture and wine production. There is a growing opportunity to communicate their current procedures and reinforce their brands associating them with sustainability. The goal of this chapter is to analyse how a landmark winery with one of the most popular Instagram accounts communicates sustainability. The authors will examine how the engage customers and communicate sustainability focusing on understanding sustainability communication practices in Bodegas Emilio Moro, the Spanish winery with largest Instagram followers. Findings will show the strategies and communication elements that depict sustainability in the popular wineries within one of the main sources of information for the visitors: social media.
From Sustainability to Regeneration
Authors: Robinson Danielle Maria
Published: April 2023

This chapter focuses on sustainability challenges in the wine industry from a tourism perspective. Wine tourism is considered an important, growing segment of the tourism sector and is a well-developed practice in many international wine-producing regions, but it comes with significant cultural, social, and environmental impacts including tourism's significant contribution to climate change and damage from overtourism. Sustainable tourism has attempted to address these issues, but serious concerns persist. The COVID-19 pandemic was an opportunity to revisit tourism's purpose and consider alternative models and approaches that better respect ecological limits and better support human flourishing. New approaches to wine tourism that go beyond sustaining tourism or minimizing tourism's negative effects are expanding. These regenerative approaches highlight wine tourism's potential to generate economic, social, cultural, and environmental benefits.
How Can Green Innovation Performance Be Improved in the Spanish Wine Industry?
Authors: Falcó Javier Martínez , Marco-Lajara Bartolomé , Sánchez-García Eduardo , Millan-Tudela Luis A.
Published: April 2023

The purpose of this chapter is to focus on analyzing how the set of green intangibles held by wineries (GIC) affects green innovation performance (GIP). Specifically, the study aims to investigate how GIP is influenced by GIC through the mediating role of the knowledge management (KM) variable and corporate social responsibility (CSR). The study proposes a conceptual model, based on previous studies, which is tested using structural equations (PLS-SEM) with data collected from 202 Spanish wineries. The research results indicate that there is a positive and significant relationship between GIC and GIP. In addition, CSR and KM partially mediate the relationship between these two variables, playing a key role in the environmental management of wineries.
Obstacles to Developing a Wine Sustainability Framework
Authors: Moscovici Daniel , Gow Jeffrey
Published: April 2023

Wine is part of the recent global trend for healthier food sources. However, there is no commonly agreed upon global certification for wine. In fact, wine has unique characteristics that make its designation as ‘sustainable' problematic. There are three distinct obstacles to developing a global sustainability framework for wine. First is related to the consumer and their lack of knowledge and information. Second is based on producers' attitudes. Third stems from the lack of agreement on what exactly certified sustainable wine is. These issues create a negative consumer-producer-certification cycle resulting in confusion and ineffective development and implementation of a widely accepted framework. This limits the global wine industry from developing large scale, measurable, and global sustainability successes. The authors make some recommendations as to how to overcome these issues. This includes education, standardization, a need for continued research, and some form of regulation to avoid deception and confusion for consumers to overcome the information problem.
Sustainability as Vehicle for Strategic Entrepreneurship
Authors: Dressler Marc
Published: April 2023

This chapter investigates strategic value of sustainability based on empirical data from German wineries. Two sources served to explore strategic aspects. An online panel filled by German wineries on strategy, innovation, and sustainability was complemented by a netnographic database on winery brand management. The results underline a leapfrogging growth of strategic importance of sustainability for German wine producers. Sustainability is becoming a strategic driver with far-reaching impulses for innovation and business model design. Sustainability accentuates the wineries´ generic positioning and offers potential for reputational differentiation. Sustainability is developing into a profiling vehicle and control instrument in the German wine industry. In particular, customer receptiveness and reputational value for strategic profiling promises sustainability further relevance. A positive performance impact nourishes expectations that sustainability can unfold transformational power in light of the market drive out and low market profitability.
Sustainable Succession in the Wine Industry
Authors: Rinck Kristen , Gilinsky Jr. Armand , Santana Adele , Bailey Caroline Coleman , Wallace Timothy , Coget Jean-François
Published: April 2023

Most studies that investigate sustainability across the wine industry and related support industries focus on the “triple-bottom-line.” None directly consider company succession planning as a sustainability driver. What skills will leaders of successive generations need? Two qualitative field research methodologies are used for this investigation: (1) content analyses of published wine business case studies and (2) focus groups with wine business leaders. Leaders continuously develop skills and capabilities. Transactional and transformational leadership converges when it came to leading the business: (1) supporting the next generation, (2) emotional intelligence, (3) industry knowledge, and (4) active listening, also known as superior communication skills. A 2x2 matrix modeling optimal vs. sub-optimal leadership styles, propositions for further research, case vignettes, and implications for practitioners are presented.
The Economic, Social, and Environmental Value of the Spanish Wine Industry
Authors: Falcó Javier Martínez , Marco-Lajara Bartolomé , Sánchez-García Eduardo , Gilinsky Jr. Armand
Published: April 2023

A comprehensive understanding of the significance of vine cultivation and wine production, distribution, and consumption in Spain requires a joint consideration of its economic, social, and environmental implications. To achieve this joint vision, a quantitative research with an exploratory scope is carried out through the use of secondary data sources. The results of the research reveal that, from an economic point of view, the wine industry generates a total annual gross value added (GVA) of more than 23,700 million euros, equivalent to 2.2% of the national GVA. From a social point of view, wine maintains an important territorial rootedness, very visible in the designations of origin (DOs), being the environment where the wine comes from an appreciated attribute of the wine. From the environmental point of view, the effects of climate change introduce more adverse conditions for the cultivation of vines and force the search for solutions, since the quality and volume of wine that can be obtained in the future in Spain are conditioned by the current climatic reality.
Wine Routes in Rural Romania
Authors: Pop Cornelia , Coros Monica Maria , Georgescu Maria Andrada
Published: April 2023

Scholars have shown the power of wine routes to boost tourist arrivals, increase destination competitiveness, and enhance sustainable development. Like in the past decades in 2019, Romania ranked 10th worldwide and 4th in the EU for its vineyard cultivated surface (ha), also ranking 13th worldwide and 6th in the EU for wine production. Romania registers a modest level of wine tourism despite the initial efforts: Romania – Land of Wines, with the sub-program Wine Route/Road, recognizing the huge potential of this form of tourism and trying to develop it, mainly in rural areas. The Master Plan for Romanian Tourism Development briefly mentioned wine tourism, without indicating any functional route/road. This chapter aims at identifying the existing wine routes in Romania's rural areas and at evaluating whether the communes along these wine routes enjoy tourism supply and demand advantages, compared to communes associated with vineyards/wineries, but not included in wine routes.
In postnatal women with nipple pain, does photobiomodulation therapy (PBMT) at 660 nm compared with sham PBMT reduce pain on breastfeeding? A case series during COVID-19
Authors: Ralph Monique , Hurst Cameron , Guyatt Sheridan , Goldsmith Kathleen , Laakso E-Liisa
Published: April 2023

The analgesic role of PBMT for breastfeeding women with nipple pain is inconclusive. This study aimed to determine the efficacy of PBMT at 660 nm in postnatal women with nipple pain planning to exclusively breastfeed. A randomised, placebo-controlled clinical study was initiated at a tertiary hospital in Brisbane, Australia on the inpatient maternity wards from May 2020 to September 2020. Eligible participants were randomised into two groups, an intervention group receiving usual care and PBMT (Group A) and a control group receiving usual care and sham PBMT (Group B). Usual care involved consultation with a midwife and/or lactation consultant to assist with infant latching and breastfeeding positioning. PBMT (660 nm; 250 Hz; 17 mW; 0.5 cm2 spot size) was administered three times within 24 hours. Nipple pain was the primary outcome measure analysed using a Visual Analogue Scale (VAS). Quality of life (QoL) and the participants’ perceived efficacy of treatment were secondary outcome measures evaluated using the PROMIS Global Short Form and a combined 5-point Likert scale and thematic analysis, respectively. Due to the impact of COVID-19, only 10 participants were recruited. Compared to sham, three applications of PBMT at 660 nm provided no significant difference to participants’ nipple pain, QoL or perceived efficacy of treatment. Three key themes of PBMT treatment were simplicity, safety and support. This study was unable to demonstrate the impact of PBMT at 660 nm on relieving nipple pain due to low participant numbers. An adequately powered RCT with COVID-19 modifications, is recommended.
First record of rare mating behavior of Javan leopard Panthera pardus melas in Indonesia
Authors: Ario Anton , Murdyatmaka Wahyu , Gitayana Awang , Hariyanto Gendut
Published: April 2023

We report the first observation of the mating behavior of the endangered Javan leopard (Panthera pardus melas) from Gunung Malabar Protected Forest in West Java and Alas Purwo National Park in East Java. We recorded the mating process of the Javan leopard using a camera trap on 20 November 2014 and 22 September 2020. We consider this to be the first record in the wild in Indonesia.
Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers’ Perceived Role of the Athletic Trainer
Authors: Drescher Matthew J. , Mills Grace , Winkelmann Zachary K. , Games Kenneth E.
Published: April 2023

Context

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT’s role on interprofessional behavioral health teams is limited.

Objective

To explore behavioral health providers’ perceived role of ATs in collaborative behavioral health care.

Design

Qualitative study.

Setting

Individual interviews.

Patients or Other Participants

Nine behavioral health care providers (women = 6, men = 3; age range = 30–59 years, years in clinical practice = 6–25) from National Collegiate Athletic Association Power 5 schools were interviewed.

Data Collection and Analysis

Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes.

Results

Three themes emerged

(1) provider experience, (2) the AT’s role in behavioral health, and (3) collaboration. Provider experience included subthemes of formal education and interaction with ATs. Subthemes of the AT’s role included care coordination, information gathering, and positive proximity. Subthemes for collaboration included structural collaboration, cultural collaboration, collaboration concerns, and suggestions for ideal collaboration.

Conclusions

Collaborative care models can enhance providers’ abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.
Regional lake sediment geochemical data from north-central Saskatchewan (NTS 074-A, B, G, and H): reanalysis data and QA/QC evaluation
Authors: Bourdeau J E , McCurdy M W , Day S J
A
Published: April 2023

This report presents the geochemical data, quality assurance and quality control (QA/QC) results of the re-analysis of lake sediment samples collected from north-central Saskatchewan (NTS 074-A, B, G and H). The original lake survey was conducted in 1986 and the
re-analysis in 2021. Original survey results are presented in OF1359. A total of 1,290 lake sediment samples were re-analyzed, covering an area of 17,000 km2, averaging a density of 1 sample per 13 km2. Samples were measured for 65 elements via modified aqua-regia - ICP-MS and 35 elements via INA
analysis. To ensure high quality data, the geochemical data was evaluated for contamination, accuracy, precision and fitness-for-purpose. QA/QC results have identified a number of elements to be monitored carefully for future analyses. Overall, the data are of good quality.
3D geological model of the Western Canadian Sedimentary Basin in Saskatchewan, Canada
Authors: Bédard K , Marsh A , Hillier M , Music Y
Published: April 2023

The Western Canadian Sedimentary Basin (WCSB) covers a large part of southern Saskatchewan and hosts many resources such as critical mineral deposits (i.e. potash, helium and lithium) as well as oil and gas reservoirs and is also targeted for deep CO2 storage
projects. There is also growing interest in the groundwater resources, the geothermal potential and hydrogen recovery potential. These applications require knowledge of the subsurface geology such as formation thickness and depth, relationships with adjacent formations or unconformities and
ultimately, distribution of physical properties within the basin. 3D geological models can provide this knowledge since they characterize the geometry of subsurface geological features. In addition, they can be used as a framework for fluid flow simulation and estimating the distribution a variety
of properties. The 3D geological model presented in this report consists of 51 geological units of which, 49 are stratigraphic units spanning from Cambrian Deadwood Formation at the base of the sequence to Upper Cretaceous Belly River Formation at the top, plus the undivided Precambrian and a
preliminary Quaternary unit. The model is cut by 7 major regional unconformities, including the base of the Quaternary sediments. The regional model was constrained using oil and gas well data interpretations, provincial scale bedrock geology maps and knowledge from the previously interpreted areal
extent of the Phanerozoic strata. A hybrid explicit-implicit modelling approach was employed to produce the 3D geological model of the WCSB in Saskatchewan using Gocad/SKUATM geomodelling software.
Diagnostic Clues for Pneumoperitoneum in Premature Infants Through Ultrasonography: Two Newborn Cases
Authors: Tepe Tugay , Ozdemir Mustafa , Konak Murat , Soylu Hanifi
Published: April 2023

ABSTRACT

Pneumoperitoneum (PP) is a life-threatening condition that requires urgent intervention depending on etiology. Besides traditional methods for detecting free air in the abdominal cavity, abdominal ultrasonography may be an alternative tool for diagnosing intestinal injuries. We report two premature infants with PP diagnosed through bedside abdominal ultrasonography (BAUS). The first case was an extremely low-birth weight infant with PP due to necrotizing enterocolitis. The second case was 35 gestational-aged premature infants who had sudden abdominal distension. Abdominal ultrasonography use is trending in follow-up, especially in intensive care units and emergency departments. It is important to perform BAUS serially as a part of point-of-care ultrasonography application and consider with the physical examination in high-risk infants.
Predictive Value of Nucleated Red Blood Cells in Diagnosis and Prognosis of Asphyxia in Preterm Neonates
Authors: Zakerihamidi Maryam , Moradi Ali , Bagheri Fatemeh , Boskabadi Hassan
Published: April 2023

ABSTRACT

Introduction:

Nucleated red blood cell (NRBC) count can be used as a simple indicator for evaluation of the severity and primary outcomes of perinatal asphyxia. The current study has aimed to define the predictive value of NRBC count in the diagnosis and outcomes of preterm neonates with asphyxia.

Materials and Methods:

This cohort study was performed on 353 preterm (gestational age <37 weeks) neonates (168 asphyxia [47.6%] and 185 nonasphyxia [52.4%] neonates) from 2017 to 2021. The neonatal data were recorded. Denver II test was performed at 6, 12, 18, and 24-month follow-up visits. The children were then categorized into two groups of favorable and nonfavorable outcomes (death or developmental delay).

Results:

NRBC count and NRBC/100 white blood count (WBC) in asphyxia preterm neonates (30 ± 69.6 × 102/mm3 and 9.6 ± 11.2) were significantly higher than nonasphyxia preterm neonates (32.3 ± 54.4 × 102/mm3 and 7.6 ± 9) (P < 0.001). Furthermore, NRBC count and NRBC/100 WBC in preterm asphyxia neonates with unfavorable outcomes (29.2 ± 52.4 × 102/mm3 and 32.17 ± 80.8 × 102/mm3) were significantly higher than those with normal outcomes (15 ± 30.4 × 102/mm3 and 10.14 ± 19.17 × 102/mm3) (P < 0.001). NRBC count >370 had sensitivity and specificity of 69.5% and 57.3%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 63.2% and 63.6% in diagnosing asphyxia in preterm neonates. Furthermore, NRBC count >370 had sensitivity and specificity of 72.6% and 53.8%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 70.5% and 65.1% for the prognosis of asphyxia preterm neonates.

Conclusions:

According to our findings, NRBC/100 WBC >370 and total NRBC >8% are suitable sensitive predictors of the prognosis of preterm neonates with asphyxia. Evaluation of NRBC count and NRBC/100 WBC can help in the diagnosis of asphyxia and prognosing unfavorable outcomes of asphyxia in asphyxia preterm neonates.
Influence of Jaw Setting in the Determination of Stereotactic Small-Field Output Factors with Different Detectors
Authors: George Seby , Ponmalar Y. Retna , Godson Henry Finlay , Kumar A. Sathish , Ravindran B. Paul
Published: April 2023

Background:

The experimental determination of relative output factors presents the greatest challenge, especially for small fields with different detectors. The aim of this study is to evaluate the influence of jaw positions on small-field output factors for the fields defined by micro-multileaf collimator and circular cones with different detectors.

Materials and Methods:

The stereotactic output factors were measured on Primus linear accelerator with BrainLab micro-multileaf collimator (mMLC) and circular cones as add-on tertiary collimators. Square field sizes ranging from 0.6 cm × 0.6 cm to 9.8 cm × 9.8 cm and circular fields of diameter ranging from 1.0 cm to 4.0 cm were defined by mMLC and circular cones, respectively. The influence of jaw position on output factor was assessed for different geometric configurations with three different detectors.

Results:

The values obtained with PinPoint ion chamber were consistent with microDiamond detector for fields greater than 24 mm × 24 mm, but an underestimation of 23.9% was noticed in 6 mm x 6 mm field size. For the mMLC defined field size of 6 mm × 6 mm, when the X-Y jaw was moved from 8 mm × 8 mm to 80 mm × 80 mm, an increase in the output by a factor of 1.7 was observed with both microDiamond and stereotactic radiosurgery diode, whereas an increase in output by a factor of 1.9 was noticed with PinPoint ion chamber.

Conclusion:

Output factors obtained with different detectors show high differences in the smallest field size for all collimating systems. This study confirms that the position of X and Y jaw above the tertiary collimator significantly influences the small-field output factor.
Original Knee Fixation Device as a Useful Fixation Method during Prostate Intensity-Modulated Radiation Therapy
Authors: Kuga Noriyuki , Shirieda Katsutoshi , Sato Yuta , Shimotabira Haruhiko , Kurogi Yusuke , Jinnouchi Takashi
Published: April 2023

Purpose:

The purpose of he study was to reduce setup errors during intensity-modulated radiation therapy (IMRT) with an original knee fixation device (KFD) and evaluate the clinical target volume (CTV) coverage.

Methods:

Participants were classified into two groups: knee flexion (KF) group (n = 16), wherein participants' knees were fixed in a flexed position using the proposed KFD during planning computed tomography, and knee extension group (KE; n = 15), wherein no KFD was used. We investigated the residual rotational errors and inter-fractional setup errors with or without KFD. Furthermore, inter-fractional margins were calculated using logistic regression analysis, and CTV coverage was evaluated.

Results:

The residual rotational errors in the yaw and roll directions (P < 0.02) and the inter-fractional error in the anterior-posterior (A-P) direction (P < 0.02) improved significantly in the KF group compared with the KE group. Repeatability was improved for the pitch direction. The inter-fractional margins were 6.68 mm and 4.87 mm in the A-P and superior-inferior (S-I) directions, respectively, in the KF group, representing reductions (mm) of 20.8% and 12.6% compared with the KE group, respectively. The odds ratios for CTV coverage in the KF group compared to the KE group were 2.76 (P < 0.001) and 1.74 (P < 0.05) in the A-P and S-I directions, respectively.

Conclusions:

The IMRT fixation method using an original KFD improved the residual rotational error in the three directions and the inter-fractional error in the A-P direction, reduced the interfractional margins in the A-P, and S-I directions and improved CTV coverage. Our original KFD may be a useful fixation method during prostate IMRT.
Monte Carlo Dose Calculation – A QA Method for SRT and SBRT Plans in Treating Multiple and Small Metastatic Lesions
Authors: Lin Teh , Wang Lu , Charlie C-M
Published: April 2023

To provide accurate and fast 3-D dose verification for hypofractionated stereotactic radiotherapy (SRT/SBRT) of small and multi targets calculated with a Varian Eclipse treatment planning system (TPS) delivered on a Varian accelerator. Ten brain and lung hypofractionated SRT/SBRT linac-based and CyberKnife plans were generated by the Eclipse system for delivery on the accelerator with the Millenium-120 leaf multileaf collimator (MLC) and Multiplan for the CyberKnife machine. These clinical SRT/SBRT plans required accurate quality assurance measurements to obtain absolute point dose and 3-D dose distributions due to the low number of fractions and high fraction doses. For small-field and multi-target plans, the EGS4/MCSIM code was used to calculate the dose distribution. A 0.125 cc ion chamber, a 0.016 cc pin-point chamber and Kodak EDR2 film were used for the measurements and the results were compared with Monte Carlo (MC) calculations. The dosimetry for small-field and multi-target treatment plans is challenging due to the comparable range of secondary electrons and the field sizes defined by SRT/SBRT MLC segments. Our MC simulations can accurately reproduce the linac dose distributions (within 1%/1 mm) three dimensionally. For the clinical SRT/SBRT plans investigated in this work, the MC doses agreed within 3% with ion chamber measurements and within 2%/2 mm with film measurements. The doses calculated by the Eclipse AAA algorithm and Multiplan differed by no more than 5% from MC calculations for small (4–40 cc) Planning Target Volumes (PTVs). MC dose calculation provides accurate and fast 3-D dose verification for hypofractionated SRT for small and multi-target treatment plans generated by a Varian Eclipse TPS on a Varian accelerator and Multiplan treatment planning on the CyberKnife System.
A Novel Hybridized Feature Extraction Approach for Lung Nodule Classification Based on Transfer Learning Technique
Authors: Bruntha P. Malin , Pandian S. Immanuel Alex , Anitha J. , Abraham Siril Sam , Kumar S. Niranjan
Published: April 2023

Purpose:

In the field of medical diagnosis, deep learning-based computer-aided detection of diseases will reduce the burden of physicians in the diagnosis of diseases especially in the case of lung cancer nodule classification.

Materials and Methods:

A hybridized model which integrates deep features from Residual Neural Network using transfer learning and handcrafted features from the histogram of oriented gradients feature descriptor is proposed to classify the lung nodules as benign or malignant. The intrinsic convolutional neural network (CNN) features have been incorporated and they can resolve the drawbacks of handcrafted features that do not completely reflect the specific characteristics of a nodule. In the meantime, they also reduce the need for a large-scale annotated dataset for CNNs. For classifying malignant nodules and benign nodules, radial basis function support vector machine is used. The proposed hybridized model is evaluated on the LIDC-IDRI dataset.

Results:

It has achieved an accuracy of 97.53%, sensitivity of 98.62%, specificity of 96.88%, precision of 95.04%, F1 score of 0.9679, false-positive rate of 3.117%, and false-negative rate of 1.38% and has been compared with other state of the art techniques.

Conclusions:

The performance of the proposed hybridized feature-based classification technique is better than the deep features-based classification technique in lung nodule classification.
Design and Evaluation of Structural Shielding of a Typical Radiotherapy Facility Using EGSnrc Monte Carlo Code
Authors: Ibitoye Zaccheaus Ayo , Adedokun Margret Bose , Orotoye Temitope Aminat , Udo Godwin Bassey
Published: April 2023

Purpose:

This study aimed to evaluate the shielding integrity of a typical radiotherapy facility using the Monte Carlo (MC) method.

Materials and Methods:

EGSnrc MC code was used to design a radiotherapy bunker with appropriate materials and thicknesses. A concrete density of 2.36 g/cm3 was used as a shielding material for primary and secondary barriers. The lead slab was used in the entrance door. The complex geometries of the bunker were modeled by using the egs++ application code embedded in the software. Phase-space generated from a linac machine built with BEAMnrc codes was used as a source of 18 MV X-ray beam set at 100 cm source–surface distance with a field size of 40 cm × 40 cm. Energy deposited in each geometrical region was evaluated and analyzed.

Results:

Energy deposited at the entrance door, supervised and controlled areas were found to be approximately 0%. No significant difference in the energy deposition on the geometries was observed when the gantry angles were set at either 90° or 270° (P = 1).

Conclusion:

The findings in this study revealed that the EGSnrc MC code can be used as a veritable tool in the design and evaluation of structural shielding efficiency in a radiotherapy facility.
Fast B1 Mapping Based on Double-Angle Method with T1 Correction Using Standard Pulse Sequence
Authors: Ishimori Yoshiyuki , Shimanuki Takeshi , Kobayashi Tomoya , Monma Masahiko
Published: April 2023

Radiofrequency (RF) field (B1) mapping by combining the double-angle method (DAM) and T1 correction was investigated. The signal intensities S1 and S2 acquired by flip angle (FA) α and double FA 2α at short repetition time (TR) were converted to a signal intensity at TR=∞ by T1 correction. Then, these were used for DAM calculation. The T1 values are measured from two different images acquired with different TRs based on the saturation recovery (SR) method preliminarily. The effects of imaging parameters for T1 estimation and measured FA were investigated using CuSO4-doped water phantoms. A two-dimensional gradient echo type echo planar imaging pulse sequence was used. T1 values obtained by the 2-SR method were underestimated compared to the multipoint inversion recovery method. FA error was less than 5% when the appropriate imaging parameters were used. The acquisition time could be shortened to under 25 s by the use of T1-corrected DAM.
Implementation and Validation of Anisotropic Analytical Algorithm in Eclipse Treatment Planning System for Indigenous Telecobalt Machine (Bhabhatron II)
Authors: Hajare Raghavendra , Ali Md. Basit , Sreelakshmi K K , Kumar M Anil , Kalita Rituraj , Mahantshetty Umesh M
Published: April 2023

Background:

The photon dose calculation model anisotropic analytical algorithm (AAA) available with eclipse integrated treatment planning system (TPS) (Varian) supports telecobalt dose calculation from Version 13.6 onward. Formerly, pencil beam convolution (PBC) was used for modeling telecobalt machines. Eclipse TPS no longer supports PBC dose calculation algorithm in v13.6 and above. The AAA dose calculation model is a three-dimensional PBC/superposition algorithm. Its configuration is based on Monte-Carlo-determined basic physical parameters that are tailored to measured clinical beam data.

Aim:

The study investigated the feasibility of clinical implementation of AAA in Eclipse TPS for Bhabhatron II.

Materials and Methods:

The indigenous telecobalt machine, Bhabhatron II, was configured as a generic machine because an inbuilt machine model for the same was not available in Varian Eclipse TPS algorithm library. In such a scenario, it was necessary to evaluate and validate dosimetric parameters of the TPS because improper tailoring would cause errors in dose calculations. Beam data measurements of the machine were carried out which were used for configuration of the algorithm.

Result:

After successful configuration, a variety of plans created in TPS were executed on the machine and subsequently evaluated.

Conclusion:

From this study, we concluded that AAA-based dose calculation in TPS is very well suited for accurate dose calculations for telecobalt machine and can be implemented for clinical use.
Comparing the effect of intermittent diazepam and continuous phenobarbital in preventing recurrent febrile seizures among children under 6 years old: A systematic review and meta-analysis
Authors: Faraji Gavgani Leili , Laghousi Delara , Sarbakhsh Parvin , Jahangiri Leila , Vahed Nafiseh , Hajebrahimi Sakineh
Published: April 2023

Background:

Febrile convulsion (FC) is the most common and preventable seizure in children. This study aimed to assess the effectiveness of the diazepam and phenobarbital for preventing recurrent FC.

Materials and Methods:

In this systematic review study, literature published in English language were carefully searched in biological databases (Cochrane Library, Medline, Scopus, CINHAL, Psycoinfo, and Proquest) by February 2020. Randomized clinical trials (RCTs) and Quasi randomized trial were included in the review. Two researchers checked the literature independently. The quality of studies was assessed using the JADAD score. The potential risk for publication bias was assessed by Funnel plot and Egger's test. Meta regression test and sensitivity analysis were used to identify the reasons for heterogeneity. Given the results of assessing heterogeneity, the random effect model in RevMan5.1 software was used for meta analysis.

Results:

Four out of 17 studies had compared the effect of diazepam and phenobarbital in preventing recurrent FC. The result of the meta analysis showed that the use of diazepam in comparison with phenobarbital reduces the risk of recurrence FC by 34% (risk ratio = 0.66, 95% confidence interval [CI] = [0.36–1.21]), but the relationship was not statistically significant. In assessing the effect of diazepam or phenobarbital versus placebo, the results showed that the use of diazepam and phenobarbital has reduced the risk of recurrent FC by 49% (risk ratio = 0.51, 95% CI = [0.32–0.79]) and 37% (risk ratio = 0.63, 95% CI = [0.42–0.96)]), respectively, and these relationships were statistically significant (P < 0.05). Results of the meta regression test showed that the follow up time can be a reason for the heterogeneity between trials with the comparison of diazepam versus phenobarbital (r = 0.047, P = 0.049) and Phenobarbital versus placebo (r = 0.022, P = 0.016). According to the results of Funnel plot and Egger's test, there was evidence of publication bias (P = 0.0584 for comparison of diazepam vs. phenobarbital; P = 0.0421 for comparison of diazepam vs. placebo; P = 0.0402 for comparison of phenobarbital vs. placebo).

Conclusion:

The results of this meta analysis indicated that preventive anticonvulsants can be useful in preventing recurrent convulsions in cases of febrile seizures.
A clinical study comparing post-operative astigmatism with straight and frown scleral incision in manual small incision cataract surgery
Authors: Seethalakshmi D. K. , Prakash Anoosha , Kanakpur Savita , Ramamurthy Lakshmi Bomalapura
Published: April 2023

Background:

Cataract surgery is considered refractive surgery. Apart from implanting the right dioptric power of Intra ocular lens (IOL), minimizing postoperative astigmatism plays an important role in good visual rehabilitation. Hence, surgical incision is of major importance in minimizing postoperative astigmatism and reducing or abolishing preexisting astigmatism.

Objectives:

The objective of this study is to compare surgically induced astigmatism (SIA) following straight and frown scleral incisions in manual small-incision cataract surgery (MSICS).

Materials and Methods:

This is a prospective randomized comparative study conducted among two groups of patients undergoing MSICS, where the straight scleral incision was performed in one group with 29 cases and the frown incision was performed in the other group with 29 cases. Postoperatively, patients were followed up on postoperative day 1, week 1, and week 6. Uncorrected visual acuity, Kv and Kh readings, and SIA were noted at each postoperative visit.

Results:

SIA on the postoperative day 1 in the straight incision group (SIG) was 1.4914D ± 1.251 and in the frown incision group (FIG) was 0.629D ± 0.288. On the postoperative week 1 in SIG, it was 0.9655D ± 0.699, and in FIG, it was 0.474D ± 0.397. On the postoperative week 6 in SIG, it was 0.8793D ± 0.599, and in FIG, it was 0.414D ± 0.286. SIA was significantly less in FIG compared to SIG (P = 0.011). Postoperative uncorrected visual acuity was better in FIG compared with SIG. More amount the rule astigmatism was noted in FIG on the postoperative 6th-week follow-up, which is favorable to the patient, while SIG witnessed more amount against the rule astigmatism.

Conclusion:

Frown incision is a better incision than the straight incision in MSICS to create a sclerocorneal tunnel.
Cartridge-based nucleic acid amplification test in drug-resistant Mycobacterium tuberculosis as compared to solid cultures
Authors: Dhakar Ashok , Singhal Anuj , Kompella Kiran Kumar , Yadav Arun Kumar , Mangal Vishal
Published: April 2023

Background:

There is a need to study the performance, validity, and accuracy of cartridge-based nucleic acid amplification test (CB-NAAT) for accessing drug resistance among pulmonary tuberculosis (TB) compared with the solid culture drug susceptibility test (DST).

Methods:

Patients with symptoms of cough for more than 2 weeks with anyone symptoms such as night sweats, fever, and unintentional weight loss were studied. Cases with previously diagnosed drug-resistant pulmonary TB by sputum CB-NAAT having constitutional symptoms but not on any ATT for a minimum of 2 months were also included in the study. The patient's information, including age, immune surveillance status, clinical features, and chest X-rays, were recorded. Each sputum sample was divided into three aliquots and tested for smear microscopy, liquid culture (LC), and genotypic DST. Results of all three diagnostic modalities were compared with CB-NAAT reports.

Results:

Of 236 patients with sputum-positive CB-NAAT (n = 236), 49.4% (n = 117) were rifampicin resistant, while 50. 4% (n = 119) were rifampicin sensitive. The genotypic DST assays carried out of all enrolled patients showed that 76.3% (n = 181) patients were resistant to one or more first-line antitubercular drugs (FL ATTs) or second-line (SL) ATTs, while 23.7% (n = 55) patients were sensitive to all ATTs. Among all the study participants, 56.4% (n = 133) of patients had sputum smear-positive by ZN stain, while 88.6% (n = 209) showed growth on LC (BACTEC) media. On concordant analysis of CB-NAAT with DST assays, we found that among 119 CB-NAAT rifampicin-sensitive patients, 66 patients were drug-resistant (DR) TB to any of the FL or SL ATTs. The sensitivity, specificity, positive predictive value, and negative predictive value of CB-NAAT for detecting rifampicin resistance on sputum for pulmonary TB when compared with the gold-standard DST assays were 97.67%, 76.67%, 70.59%, and 98.29%, respectively.

Conclusions:

This study found that the use of rapid molecular technique (CB-NAAT) in screening DRTB at the community level is suboptimal compared to the gold-standard solid culture method. Although CB-NAAT's sensitivity in detecting DR pulmonary TB is significantly higher, the specificity is lower in that population who have received ATT earlier.
Social stigma and associated factors among COVID-19 survivors at a tertiary care centre from Visakhapatnam
Authors: Latha Bangi Suma , Moses Pidakala Mary , Karini Deepthi , Narni Hanumanth
Published: April 2023

Background:

From the early days of the HIV epidemic to the current COVID-19 crisis, a major challenge around infectious diseases has been dealing with the deep-seated stigma around affected populations. There is a paucity of literature on the prevalence of social stigma among patients who survived after COVID-19 infection in India.

Objective:

The objective is to estimate the prevalence of social stigma and its associated factors among COVID-19 survivors.

Methodology:

It was a cross-sectional study conducted among 150 COVID-19 survivors with predesigned questionnaire using a simple random sampling technique in a tertiary care center from October to November 2020. Social stigma was measured for different socio-demographic parameters and compared.

Results:

Of 150 study subjects, 29.3% of them faced social discrimination. Majority of them were discriminated by neighbors (75%) and even by their family members and 11.4% not allowed them into community/village. 50% had fear of infecting others and 55.3% of them blamed themselves for getting COVID-19 infection. 18% had faced social devaluation by others. 23.3% lost their job due to COVID-19 and 40.7% had economic loss.

Conclusion:

COVID-19-related stigma was widespread among participants. Social discrimination was more with increased age, female gender, among educated people, in joint families, among married individuals, in upper social class and those who had a long hospital stay; however, it was not significantly associated statistically.
Incidence and prevalence of oral candidal colonization in patients with cleft lip and palate
Authors: Khan Imran , Ahmedi Saiema , Ahmad Tanveer , Rizvi M Moshaid Alam , Manzoor Nikhat
Published: April 2023

Aims and Objectives:

This study aims to assess and compare the incidence and rate of oral candidal colonization in patients with cleft lip and palate and collate it with healthy individuals. The objectives of this study were to evaluate the factors that may affect the incidence, rate, and polycolonity of colonization of oral Candida species in patients with cleft lip and palate (CLP) as compared to healthy individuals.

Materials and Methods:

The current prospective study involved the collection and assessment of oral samples from 50 CLP patients and compared it with oral samples from 50 healthy individuals. Colonies of Candida albicans and other Candida species were identified by using germ tube test and differential chromogenic media. Assessment of the distribution trend of various Candida species and their variation based on age, gender, type of cleft, number of surgeries, and oral hygiene status were recorded.

Results:

A highly significant (P value < 0.001) statistical difference was seen in the oral carriage rate of Candida species between the two groups with values more in the study group (60.75 ± 71.43) than in controls (1.62 ± 2.22). Individually comparing the different Candida species, significant difference in presence of C albicans (P value = 0.004), C parapsilosis (P value = 0.015), and C dubliensis (P value = 0.027) was seen as compared to other species. In the context of the type of cleft and the presence of Candida species Candida albicans was the most prevalent in patients with the cleft alveolus (60.0% n = 15), unilateral CLP (66.7% n = 8), and bilateral CLP (100.0% n = 3) respectively. Nonsignificant variation in prevalence was seen in the various fungal species based on an individual’s gender and oral hygiene and the number of surgeries status was observed.

Conclusion:

The anatomical alteration in the oral cavity of patients with CLP contributes to the high incidence and prevalence of Candida species.