bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new homogeneity index based on statistical analysis of the dose–volume histogram
Authors: Yoon Myonggeun , Park Sung Yong , Shin Dongho , Lee Se Byeong , Pyo Hong Ryull , Kim Dae Yong , Cho Kwan Ho 
Published: February 2017

The goal of the present study was to develop a new dose–volume histogram (DVH)– based homogeneity index for effectively evaluating the dose homogeneity of intensity‐modulated radiotherapy plans. The new index, called the sigma‐index (“S‐index”) is defined as the standard deviation of the normalized differential DVH curve. In a study of 16 patients with brain tumors at our institution, the S‐index was found to vary from 0.80 to 3.15. Our results showed that the S‐index provides a more reliable and accurate measure of dose homogeneity than that given by conventional methods. A guideline for evaluating the dose homogeneity of treatment plans based on the S‐index and its relation to equivalent uniform dose is discussed.PACS numbers: 87.53.Xd, 87.53.Tf
Dosimetric evaluation of a newly designed low dose rate brachytherapy applicator for treatment of cervical cancer with extension into the lower vagina
Authors: Baker Curtis , Dini Sharifeh A. , Kudrimoti Mahesh , Awan Shahid B. , Meigooni Ali S. 
Published: February 2017

Currently, patients having cervical cancer with extension into the lower vagina are being treated with a combination of the Fletcher–Suit applicator, which treats the cervix, and a vaginal cylinder, which treats the lower vagina. With this method, patients receive two separate implants—a procedure that creates greater uncertainty in the dose distribution and unnecessary patient inconvenience.To reduce the uncertainty of the dose delivery and to eliminate patient inconvenience, a new applicator was designed and fabricated at the University of Kentucky for treatment of cervical cancer extending into the lower vagina. In addition, the geometric design of the new device allows for treatment of cervical cancer without extension into the lower vagina and simultaneously provides advantages relative to the commonly used Fletcher–Suit applicator.The dosimetric characteristics of this new applicator (hereafter called Meigooni applicator) were determined using experimental procedures. The measurements were performed using tissue‐equivalent phantom material (Solid Water: Gammex RMI, Middleton, WI) that was machined to accommodate the applicator and LiF thermoluminescent dosimetry chips. The applicator was loaded with brachytherapy sources in a standard loading scheme. A similar experimental procedure was performed using the currently available Fletcher–Suit mini‐ovoid applicator. The results obtained with each applicator were compared with the values calculated by two commercially available treatment planning systems.The experiments showed that the Meigooni applicator allows for safe single treatment of cervical cancer that has extended into the lower vagina, eliminating the need for two separate treatment techniques. Moreover, the Meigooni applicator can function as an alternative to the Fletcher–Suit applicator for the treatment of patients with cervical cancer.PACS number: 87.53.Jw
Calculating percent depth dose with the electron pencil‐beam redefinition algorithm
Authors: Price Michael J. , Hogstrom Kenneth R. , Antolak John A. , White R. Allen , Bloch Charles D. , Boyd Robert A 
Published: February 2017

In the present work, we investigated the accuracy of the electron pencil‐beam redefinition algorithm (PBRA) in calculating central‐axis percent depth dose in water for rectangular fields. The PBRA energy correction factor C(E) was determined so that PBRA‐calculated percent depth dose best matched the percent depth dose measured in water. The hypothesis tested was that a method can be implemented into the PBRA that will enable the algorithm to calculate central‐axis percent depth dose in water at a 100‐cm source‐to‐surface distance (SSD) with an accuracy of 2% or 1‐mm distance to agreement for rectangular field sizes cm. Preliminary investigations showed that C(E), determined using a single percent depth dose for a large field (that is, having side‐scatter equilibrium), was insufficient for the PBRA to accurately calculate percent depth dose for all square fields cm. Therefore, two alternative methods for determining C(E) were investigated. In Method 1, C(E), modeled as a polynomial in energy, was determined by fitting the PBRA calculations to individual rectangular‐field percent depth doses. In Method 2, C(E) for square fields, described by a polynomial in both energy and side of square W [that is, ], was determined by fitting the PBRA calculations to measured percent depth dose for a small number of square fields. Using the function C(E, W), C(E) for other square fields was determined, and C(E) for rectangular field sizes was determined using the geometric mean of C(E) for the two measured square fields of the dimension of the rectangle (square root method). Using both methods, PBRA calculations were evaluated by comparison with measured square‐field and derived rectangular‐field percent depth doses at 100‐cm SSD for the Siemens Primus radiotherapy accelerator equipped with a ‐cm applicator at 10 MeV and 15 MeV. To improve the fit of C(E) and C(E, W) to the electron component of percent depth dose, it was necessary to modify the PBRA's photon depth dose model to include dose buildup. Results showed that, using both methods, the PBRA was able to predict percent depth dose within criteria for all square and rectangular fields. Results showed that second‐ or third‐order polynomials in energy (Methods 1 and 2) and in field size (Method 2) were typically required. Although the time for dose calculation using Method 1 is approximately twice that using Method 2, we recommend that Method 1 be used for clinical implementation of the PBRA because it is more accurate (most measured depth doses predicted within approximately 1%) and simpler to implement.PACS number: 87.53.Fs
The slow evolution of CS for all, the beauty of programs
Authors: Guzdial Mark , Hill Robin K. 
Published: February 2017

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Mark Guzdial considers the steps needed to reach the goal of CS for All, while Robin K. Hill ponders the aesthetics of programming.
Evaluating Predictor Strategies for Regression-Based Downscaling with a Focus on Glacierized Mountain Environments
Authors: Hofer Marlis , Nemec Johanna , Cullen Nicolas J. , Weber Markus 
Published: February 2017

AbstractThis study explores the potential of different predictor strategies for improving the performance of regression-based downscaling approaches. The investigated local-scale target variables are precipitation, air temperature, wind speed, relative humidity, and global radiation, all at a daily time scale. Observations of these target variables are assessed from three sites in close proximity to mountain glaciers: 1) the Vernagtbach station in the European Alps, 2) the Artesonraju measuring site in the tropical South American Andes, and 3) the Mount Brewster measuring site in the Southern Alps of New Zealand. The large-scale dataset being evaluated is the ERA-Interim dataset. In the downscaling procedure, particular emphasis is put on developing efficient yet not overfit models from the limited information in the temporally short (typically a few years) observational records of the high mountain sites. For direct (univariate) predictors, optimum scale analysis turns out to be a powerful means to improve the forecast skill without the need to increase the downscaling model complexity. Yet the traditional (multivariate) predictor sets show generally higher skill than the direct predictors for all variables, sites, and days of the year. Only in the case of large sampling uncertainty (identified here to particularly affect observed precipitation) is the use of univariate predictor options justified. Overall, the authors find a range in forecast skill among the different predictor options applied in the literature up to 0.5 (where 0 indicates no skill, and 1 represents perfect skill). This highlights that a sophisticated predictor selection (as presented in this study) is essential in the development of realistic, local-scale scenarios by means of downscaling.
The Modulating Influence of Indian Ocean Sea Surface Temperatures on Australian Region Seasonal Tropical Cyclone Counts
Authors: Ramsay H. A. , Richman M. B. , Leslie L. M. 
Published: February 2017

The Australian region seasonal tropical cyclone count (TCC) maintained a robust statistical relationship with El Niño–Southern Oscillation (ENSO), with skillful forecasts of above (below) average TCC during La Niña (El Niño) years from 1969 until about 1998, weakening thereafter. The current study identifies an additional climate driver that mitigates the loss of predictive skill for Australian TCC after about 1998. It is found that the seasonal Australian TCC is strongly modulated by a southwest-to-northeast-oriented dipole in Indian Ocean sea surface temperature anomalies (SSTAs), referred to here as the transverse Indian Ocean dipole (TIOD). The TIOD emerges as the leading mode of detrended Indian Ocean SSTAs in the Southern Hemisphere during late winter and spring. Active (inactive) TC seasons are linked to positive (negative) TIOD phases, most notably during August–October immediately preceding the TC season, when SSTAs northwest of Australia, in the northeast pole of the TIOD, are positive (negative).To provide a physical interpretation of the TIOD–TCC relationship, 850-hPa zonal winds, 850-hPa relative vorticity, and 600-hPa relative humidity are composited for positive and negative TIOD phases, providing results consistent with observed TCC modulation. Correlations between ENSO and TCC weaken from 1998 onward, becoming statistically insignificant, whereas the TIOD–TCC correlation remains statistically significant until 2003. Overall, TIOD outperforms Niño-4 SSTA as a TCC predictor (46% skill increase since about 1998), when used individually or with Niño-4. The combination of TIOD and Niño 4 provide a skill increase (up to 33%) over climatology, demonstrating reliably accurate seasonal predictions of Australian region TCC.
Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness
Authors: Lambert Timothy JR , Reavley Nicola J , Jorm Anthony F , Oakley Browne Mark A 
Published: February 2017

Objective: To use expert consensus to inform the development of policy and guidelines for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. Method: The Delphi method was used. A systematic search of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on a priori-defined levels of importance written into the expert consensus statement. Results: The participation rate for the clinicians across all three rounds was 65%, with consumers and carers only completing one round due to high endorsement rates. Finally, 386 strategies were endorsed as essential or important by one or all panels. The endorsed strategies provided information on engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side effects; and the role of health professionals. Conclusion: The consensus statement is intended to be used by health professionals, people with an enduring psychotic illness and their families and carers. The next step needed is an implementation strategy by the Royal Australian and New Zealand College of Psychiatrists and other stakeholders.
Missions involvement and interfaith relations: Forming pathways of commonality
Authors: Earl Arville , Earl Shelia 
Published: February 2017

The reality of an ever-accelerating globalization, accompanied by an expanding religious pluralism, presents significant challenges to many long-enduring concepts of doing missions. This article will focus on identifying some of those challenges and offering some possible options for ongoing missions involvement. Particular attention will be given to the potential of melding missions practices with the nurturing of interfaith relationships with the prospect of forming covenants of commonality. It is our premise that continuing interfaith conversations will break down barriers of misunderstanding and facilitate the growth of mutually compatible relationships across delicate cultural and religious boundary lines. Within the context of these developing cross-faith relationships, probable new opportunities for effectual missions ministry will emerge. In developing this article, we will draw from multiple sources, including published works by notable scholars of missiology, theology, ethics, and sociology. Songs, hymns, poems, and prayers will provide helpful illustrations. Additional material will come from real-life interfaith interchanges and from our personal experiences while serving as missions practitioners in West Africa and Eastern Europe.
The servant that brings light
Authors: Stone Meredith J. 
Published: February 2017

Isaiah 42:1–9 and 49:1–6 are prophecies that describe the servant of the Lord as an entity that will bring justice and salvation for all, including being “a light to the nations.” The implications of “light to the nations” imagery have tended to include a presumption that the nations are in darkness and that darkness is an undesirable state. This expository article will consider the identity, activity, and function of the servant of the Lord in both passages, and examine imperial and racial implications of “light to the nations” imagery. It will interpret the servant’s role as enacting justice, light, among all people. Further, it will deconstruct the negative implications of darkness and its exclusive equation with the nations, as both Israel and the servant, in addition to the nations, exhibit characteristics of and parallel constructions to darkness in the passage. Instead of understanding darkness negatively and as only associated with the nations, this article will interpret the passages to present darkness as a place in which the potential of God’s transformative activity is at its height.
Periradicular infiltration of the lumbar spine: testing the robustness of an interventional ultra-low-dose protocol at different body mass index levels
Authors: Elsholtz Fabian Henry Jürgen , Schaafs Lars-Arne , Köhlitz Thorsten , Hamm Bernd , Niehues Stefan Markus 
Published: February 2017

Background Computed tomography (CT)-guided periradicular infiltration remains a frequent interventional procedure for treatment of low back pain. Purpose To present an interventional ultra-low-dose protocol for CT-guided periradicular infiltration therapy and assess its application at different body mass index (BMI) levels. Material and Methods Over a period of 14 months, 79 patients underwent 183 CT-guided interventions for single-site lumbar periradicular therapy using an ultra-low-dose protocol with a basic setup of 100 kV and 5 mAs. Procedures were performed via intermittent fluoroscopy. A retrospective review was performed to analyze the parameters tube current and tube voltage, dose-length product, and BMI. Results The interventional ultra-low-dose protocol allowed safe treatment of 91.1% of the patients without a need for adapting the protocol. In seven patients with a higher BMI (range, 31–38 kg/m2; mean, 34 kg/m2), the tube current had to be increased to retain sufficient image quality. Only patients with a BMI of 30 and higher showed a significant correlation between BMI and dose-length product ( P value = 0.02), resulting in a slightly increased dose ( P value = 0.002). Conclusion The protocol presented for the interventional part of CT-guided periradicular infiltration allows to safely treat patients with a median calculated effective dose of 0.045 mSv (converted from a dose-length-product of 2.26 mGy*cm). Patients with a BMI of 30 and higher required a higher calculated effective dose with just one patient slightly exceeding 0.1 mSv.
Histogram analysis of apparent diffusion coefficient for monitoring early response in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy
Authors: Meng Jie , Zhu Lijing , Zhu Li , Ge Yun , He Jian , Zhou Zhengyang , Yang Xiaofeng 
Published: February 2017

Background Apparent diffusion coefficient (ADC) histogram analysis has been widely used in determining tumor prognosis. Purpose To investigate the dynamic changes of ADC histogram parameters during concurrent chemo-radiotherapy (CCRT) in patients with advanced cervical cancers. Material and Methods This prospective study enrolled 32 patients with advanced cervical cancers undergoing CCRT who received diffusion-weighted (DW) magnetic resonance imaging (MRI) before CCRT, at the end of the second and fourth week during CCRT and one month after CCRT completion. The ADC histogram for the entire tumor volume was generated, and a series of histogram parameters was obtained. Dynamic changes of those parameters in cervical cancers were investigated as early biomarkers for treatment response. Results All histogram parameters except AUClow showed significant changes during CCRT (all P < 0.05). There were three variable trends involving different parameters. The mode, 5th, 10th, and 25th percentiles showed similar early increase rates (33.33%, 33.99%, 34.12%, and 30.49%, respectively) at the end of the second week of CCRT. The pre-CCRT 5th and 25th percentiles of the complete response (CR) group were significantly lower than those of the partial response (PR) group. Conclusion A series of ADC histogram parameters of cervical cancers changed significantly at the early stage of CCRT, indicating their potential in monitoring early tumor response to therapy.
Anatomic Reconstruction of the Anterior Cruciate Ligament of the Knee With or Without Reconstruction of the Anterolateral Ligament: A Randomized Clinical Trial
Authors: Ibrahim Samir Abdulrazik , Shohdy Emad Mureed , Marwan Yousef , Ramadan Sami Abdulghaffar , Almisfer Abdulrahman Khalid , Mohammad Mohammad Wagdy , Abdulsattar Wael Shoabe , Khirat Shiref 
Published: February 2017

Background: Rotational instability of the knee remains an issue after anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to evaluate the subjective and objective outcomes of combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. The hypothesis was that favorable outcomes can be achieved with this surgical procedure compared with isolated anatomic reconstruction of the ACL. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: One hundred ten patients with a unilateral ACL injury and high-grade pivot shift were randomly assigned to undergo either combined ACL and ALL reconstruction (group A) or isolated ACL reconstruction (group B). Preoperative and postoperative evaluations of the patients were conducted by obtaining history details, recording physical examination findings, measuring knee laxity using the KT-1000 arthrometer, and using validated outcome scores for the knee. P < .05 was considered as the cut-off level of statistical significance. The Fisher exact and Mann-Whitney U tests were used to assess statistical significance. Results: At a mean follow-up of 27 months, 53 and 50 patients in groups A and B, respectively, were available for analysis. No statistically different outcomes were found between the 2 groups except for the KT-1000 arthrometer values. The median KT-1000 arthrometer result for combined ACL and ALL reconstruction was 1.3 mm, while the median result for isolated ACL reconstruction was 1.8 mm ( P < .001). None of the patients (n = 0; 0.0%) who underwent combined ACL and ALL reconstruction had anterior translation of greater than 5 mm at maximum pulling strength compared with their normal knees at final follow-up. On the other hand, 3 (6.0%) patients who underwent isolated ACL reconstruction had anterior translation of more than 5 mm. No serious complications were found in both groups. Conclusion: Combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Nevertheless, these findings were not significantly superior to isolated ACL reconstruction except for the instrumented knee laxity testing results. This might indicate that ALL reconstruction should not be performed routinely for patients undergoing ACL reconstruction.
Tension Regulation at the Suture Lines for Repair of Neglected Achilles Tendon Laceration
Authors: Massoud Elsayed Ibraheem Elsayed 
Published: February 2017

Background: Operative intervention is the preferred option for management of the neglected laceration of the Achilles tendon. However, the commonly used techniques rarely follow the principles of the regenerative medicine for the restoration of the lost tissue. This study postulated that incorporation of the autogenous tendon graft would properly progress when the interplay between mechanical loading and healing phases was correctly applied. Methods: A prospective study included 15 patients who were treated for neglected Achilles tendon laceration using the technique of lengthening of the proximal tendon stump. An absorbable reinforcement suture was used for control of the mechanical environment at the suture lines. Results: By an average 5 years of the prospective follow-up, all the repaired tendons had restored continuity and length. The calf circumference equalized to the uninjured side in 12 patients. However, 3 patients had calf atrophy but they improved compared to the preoperative measurements. Sonogram confirmed the restoration of the normal thickness and the gliding characteristics of the repaired tendon. Conclusion: The technique restored continuity and tension of the repaired tendon, preserved the calf circumference, and prevented peritendinous adhesions. The absorbable reinforcement suture spontaneously allowed for the mechanical loading of the grafted tendon. Level of Evidence: Level IV, case series.