bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sci‐Fri AM: Quality, Safety, and Professional Issues 02: Recent work on TQC Suite and Data from a National survey on Community Uptake
Authors: Malkoske Kyle , Nielsen Michelle , Brown Erika , Diamond Kevin , Frenière Normand , Grant John , Pomerleau‐Dalcourt Natalie , Schella Jason , Schreiner L. John , Tantot Laurent , Barajas Eduardo Villareal , Sasaki David , Milette Marie‐Pierre , Bertrand Marie‐Joëlle , Bissonnette Jean‐Pierre 
Published: August 2016

The Canadian Partnership for Quality Radiotherapy (CPQR) and the Canadian Organization of Medical Physicist's (COMP) Quality Assurance and Radiation Safety Advisory Committee (QARSAC) have worked together in the development of a suite of Technical Quality Control (TQC) Guidelines for radiation treatment equipment and technologies, that outline specific performance objectives and criteria that equipment should meet in order to assure an acceptable level of radiation treatment quality.Early community engagement and uptake survey data showed 70% of Canadian centers are part of this process and that the data in the guideline documents reflect, and are influencing the way Canadian radiation treatment centres run their technical quality control programs.As the TQC development framework matured as a cross‐country initiative, guidance documents have been developed in many clinical technologies. Recently, there have been new TQC documents initiated for Gamma Knife and Cyberknife technologies where the entire communities within Canada are involved in the review process.At the same time, QARSAC reviewed the suite as a whole for the first time and it was found that some tests and tolerances overlapped across multiple documents as single tests could pertain to multiple quality control areas. The work to streamline the entire suite has allowed for improved usability of the suite while keeping the integrity of single quality control areas. The suite will be published by the JACMP, in the coming year.
Sci‐Fri AM: Quality, Safety, and Professional Issues 03: The Increasing Costs of Shielding Diagnostic CT Scanners in Ontario
Authors: Richer Jeff , Frimeth Jeff , Nesbitt James 
Published: August 2016

Purpose:In Ontario, shielding for all X‐ray machines, including CT scanners, must be evaluated according to Safety Code 20A (Health Canada, 1983) which is based on NCRP‐49 (NCRP, 1976).NCRP‐147 (NCRP, 2004) is the international standard for shielding calculations of CT scanners and is also referenced in Safety Code 35 (Health Canada, 2008) which, was published to supersede SC20A. The goal of this work is to demonstrate the cost effectiveness of NCRP‐147 for CT scanner shielding.Methods:CT scanner shielding calculations are performed using SC20A and NCRP‐147:

A room located on the third floor with the nearest building 75m away
A room with high occupancy uncontrolled adjacent spaces
Two side by side rooms on the main floorResults:1. SC20A: The exterior windows required 0.1mm of Pb to protect the public who may occupy the building at 75m.1. NCRP‐147: No additional shielding required.2. SC20A: Two walls adjacent to high occupancy uncontrolled space required an additional 1.58mm Pb.2. NCRP‐147: No additional shielding required.3. SC20A: The entire floor and ceiling slabs in both rooms required an additional 0.79mm Pb. In addition, 0.79mm Pb was added to the walls from the ceiling to overlap the existing Pb shielding in the walls.3. NCRP‐147: No additional shielding required.Conclusion:The application of NCRP Report No. 147 affords the required protection to staff and the public, in the true spirit of the ALARA principle, taking into account relevant social and economic factors.
Sci‐Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques ‐ 03: The Potential Benefit Of Esophageal Sparing During Palliative Radiotherapy For Lung Cancer
Authors: Granton Patrick V. , Palma David A. , Louie Alexander V. 
Published: August 2016

Puropose:Palliative radiotherapy is an effective technique to alleviate systems of disease burden in late‐stage lung cancer patients. Previous randomized controlled studies demonstrated a survival benefit in patients with good performance status at radiation doses of 35Gy10 or greater but with an increased incidence of esophagitis. The objective of this planning study was to assess the potential impact of esophageal‐sparing IMRT (ES‐IMRT) compared to the current standard of care using parallel‐opposed pair beams (POP).Methods:In this study, 15 patients with lung cancer treated to a dose of 30Gy in 10 fractions between August 2015 and January 2016 were identified. Radiation treatment plans were optimized using ES‐IMRT by limiting the max esophagus point dose to 24Gy. Using published Lyman‐Kutcher‐Burman normal tissue complication probabilities (LKB‐NTCP) models, both plans were evaluated for the likelihood of esophagitis (≥ grade 2) and pneumonitis (≥ grade 2).Results:Using ES‐IMRT, the median esophageal and lung mean doses reduced from 16 and 8Gy to 7 and 7Gy, respectively. Using the LKB models, the theoretical probability of symptomatic esophagitis and pneumonitis reduced from 13 to 1%, and from 5 to 3%, respectively. The median NTD mean for the GTV and PTV of the clinically approved POP plans compared to the ES‐IMRT plans were similar.Conclusions:Advanced radiotherapy techniques such as ES‐IMRT may have clinical utility in reducing treatment‐related toxicity in advanced lung cancer patients. Our data suggests that the rate of esophagitis can be reduced without compromising tumour control.
Sci‐Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques ‐ 11: Quantification of chest wall motion during deep inspiration breast hold treatments using cine EPID images and a physics based algorithm
Authors: Alpuche Aviles Jorge E. , Sasaki David , Rivest Ryan , VanBeek Timothy , Akra Mohamed 
Published: August 2016

Purpose:This work presents an algorithm used to quantify intra‐fraction motion for patients treated using deep inspiration breath hold (DIBH). The algorithm quantifies the position of the chest wall in breast tangent fields using electronic portal images.Methods:The algorithm assumes that image profiles, taken along a direction perpendicular to the medial border of the field, follow a monotonically and smooth decreasing function. This assumption is invalid in the presence of lung and can be used to calculate chest wall position. The algorithm was validated by determining the position of the chest wall for varying field edge positions in portal images of a thoracic phantom. The algorithm was used to quantify intra‐fraction motion in cine images for 7 patients treated with DIBH.Results:Phantom results show that changes in the distance between chest wall and field edge were accurate within 0.1 mm on average. For a fixed field edge, the algorithm calculates the position of the chest wall with a 0.2 mm standard deviation. Intra‐fraction motion for DIBH patients was within 1 mm 91.4% of the time and within 1.5 mm 97.9% of the time. The maximum intra‐fraction motion was 3.0 mm.Conclusions:A physics based algorithm was developed and can be used to quantify the position of chest wall irradiated in tangent portal images with an accuracy of 0.1 mm and precision of 0.6 mm. Intra‐fraction motion for patients treated with DIBH at our clinic is less than 3 mm.
Sci‐Sat AM: Radiation Dosimetry and Practical Therapy Solutions ‐ 07: A mould room in a box – 3D scanning and printing technology in the radiotherapy clinic
Authors: Sasaki David , Rickey Daniel , Dubey Arbind , Alpuche Aviles Jorge E. , Johnson Kate , Sharma Ankur , Leylek Ahmet , Harris Chad , Boyer Todd , McCurdy Boyd , Butler Jim , Koul Rashmi 
Published: August 2016

Purpose:We describe the process by which our centre is currently implementing 3D printing and scanning technology for treatment accessory fabrication. This technology can increase efficiency and accuracy of accessory design, production and placement during daily use.Methods:A low‐cost 3D printer and 3D optical scanner have been purchased and are being commissioned for clinical use. Commissioning includes assessing: the accuracy of the 3D scanner through comparison with high resolution CT images; the dosimetric characteristics of polylactic acid (PLA) for electron beams; the clinical utility of the technology, and; methods for quality assurance.Results:The agreement between meshes generated using the 3D scanner and CT data was within 2 millimeters for an anthropomorphic head phantom. In terms of electron beam attenuation, 1 centimetre of printed PLA was found equivalent to 1.17 cm of water. In proof‐of‐concept tests, several types of treatment accessories have been prototyped to date that will benefit from this technology. These include electron and photon bolus for areas with complex surface contours including the ear for electron treatments, the extremities for photon treatments and lead shielding for orthovoltage treatments. Imaging with CT and x‐ray showed minimal defects, which will have no significant clinical impact. Geometric fidelity and fit to volunteers and patients was found to be excellent.Conclusions:3D Printing and scanning can increase efficiency in the clinic for treatments requiring custom accessories. Customized boluses and shielding had excellent fit and reduced uncertainty in positioning.
Sci‐Sat AM: Radiation Dosimetry and Practical Therapy Solutions ‐ 11: Commissioning of a system for the measurement of electron stopping powers
Authors: McEwen Malcolm , Roy Timothy , Tessier Frederic 
Published: August 2016

Purpose:To develop the techniques required to experimentally determine electron stopping powers for application in primary standards and dosimetry protocols.Method and Materials:A large‐volume HPGe detector system (>80% efficiency) was commissioned for the measurement of high energy (5–35 MeV) electron beams. As a proof of principle the system was used with a Y‐90/Sr‐90 radioactive source. Thin plates of absorbing material (< 0.1 gcm‐2) were then placed between the source and detector and the emerging electron spectrum was acquired. The full experimental geometry was modelled using the EGSnrc package to validate the detector design, optimize the experimental setup and compare measured and calculated spectra.Results:The biggest challenge using a beta source was to identify a robust spectral parameter to determine for each measurement. An end‐point‐fitting routine was used to determine the maximum energy, Emax, of the beta spectrum for each absorber thickness t. The parameter dEmax/dt is related to the electron stopping power and the same routine was applied to both measured and simulated spectra. Although the standard uncertainty in dEmax/dt was of the order of 5 %, by taking the ratio of measured and Monte Carlo values for dEmax/dt the uncertainty of the fitting routine was eliminated and the uncertainty was reduced to less than 2 %. The agreement between measurement and simulation was within this uncertainty estimate.Conclusion:The investigation confirmed the experimental approach and demonstrated that EGSnrc could accurately determine correction factors that will be required for the final measurement setup in a linac beam.
NS1 Protein Mutation I64T Affects Interferon Responses and Virulence of Circulating H3N2 Human Influenza A Viruses
Authors: DeDiego Marta L. , Nogales Aitor , Lambert-Emo Kris , Martinez-Sobrido Luis , Topham David J. 
Published: August 2016

ABSTRACT
Influenza NS1 protein is the main viral protein counteracting host innate immune responses, allowing the virus to efficiently replicate in interferon (IFN)-competent systems. In this study, we analyzed NS1 protein variability within influenza A (IAV) H3N2 viruses infecting humans during the 2012-2013 season. We also evaluated the impact of the mutations on the ability of NS1 proteins to inhibit host innate immune responses and general gene expression. Surprisingly, a previously unidentified mutation in the double-stranded RNA (dsRNA)-binding domain (I64T) decreased NS1-mediated general inhibition of host protein synthesis by decreasing its interaction with cleavage and polyadenylation specificity factor 30 (CPSF30), leading to increased innate immune responses after viral infection. Notably, a recombinant A/Puerto Rico/8/34 H1N1 virus encoding the H3N2 NS1-T64 protein was highly attenuated in mice, most likely because of its ability to induce higher antiviral IFN responses at early times after infection and because this virus is highly sensitive to the IFN-induced antiviral state. Interestingly, using peripheral blood mononuclear cells (PBMCs) collected at the acute visit (2 to 3 days after infection), we show that the subject infected with the NS1-T64 attenuated virus has diminished responses to interferon and to interferon induction, suggesting why this subject could be infected with this highly IFN-sensitive virus. These data demonstrate the importance of influenza virus surveillance in identifying new mutations in the NS1 protein, affecting its ability to inhibit innate immune responses and, as a consequence, the pathogenicity of the virus.

IMPORTANCE
Influenza A and B viruses are one of the most common causes of respiratory infections in humans, causing 1 billion infections and between 300,000 and 500,000 deaths annually. Influenza virus surveillance to identify new mutations in the NS1 protein affecting innate immune responses and, as a consequence, the pathogenicity of the circulating viruses is highly relevant. Here, we analyzed amino acid variability in the NS1 proteins from human seasonal viruses and the effect of the mutations in innate immune responses and virus pathogenesis. A previously unidentified mutation in the dsRNA-binding domain decreased NS1-mediated general inhibition of host protein synthesis and the interaction of the protein with CPSF30. This mutation led to increased innate immune responses after viral infection, augmented IFN sensitivity, and virus attenuation in mice. Interestingly, using PBMCs, the subject infected with the virus encoding the attenuating mutation induced decreased antiviral responses, suggesting why this subject could be infected with this virus.
Equine Rhinitis A Virus Mutants with Altered Acid Resistance Unveil a Key Role of VP3 and Intrasubunit Interactions in the Control of the pH Stability of the Aphthovirus Capsid
Authors: Caridi Flavia , Cañas-Arranz Rodrigo , Vázquez-Calvo Angela , Sobrino Francisco , Martín-Acebes Miguel A. 
Published: August 2016

ABSTRACT
Equine rhinitis A virus (ERAV) is a picornavirus associated with respiratory disease in horses and is genetically closely related to foot-and-mouth disease virus (FMDV), the prototype aphthovirus. ERAV has recently gained interest as an FMDV alternative for the study of aphthovirus biology, including cell entry and uncoating or antiviral testing. As described for FMDV, current data support that acidic pH inside cellular endosomes triggers ERAV uncoating. In order to provide further insights into aphthovirus uncoating mechanism, we have isolated a panel of ERAV mutants with altered acid sensitivity and that differed on their degree of sensitivity to the inhibition of endosome acidification. These results provide functional evidence of the involvement of acidic pH on ERAV uncoating within endosomes. Remarkably, all amino acid substitutions found in acid-labile or acid-resistant ERAVs were located in the capsid protein VP3, indicating that this protein plays a pivotal role for the control of pH stability of the ERAV capsid. Moreover, all amino acid substitutions mapped at the intraprotomer interface between VP3 and VP2 or between VP3 and the N terminus of VP1. These results expand our knowledge on the regions that regulate the acid stability of aphthovirus capsid and should be taken into account when using ERAV as a surrogate of FMDV.

IMPORTANCE
The viral capsid constitutes a sort of dynamic nanomachine that protects the viral genome against environmental assaults while accomplishing important functions such as receptor attachment for viral entry or genome release. We have explored the molecular determinants of aphthovirus capsid stability by isolating and characterizing a panel of equine rhinitis A virus mutants that differed on their acid sensitivity. All the mutations were located within a specific region of the capsid, the intraprotomer interface among capsid proteins, thus providing new insights into the regions that control the acid stability of aphthovirus capsid. These findings could positively contribute to the development of antiviral approaches targeting aphthovirus uncoating or the refinement of vaccine strategies based on capsid stabilization.
PROLONGED INFUSIONS OF KETAMINE AND IMPACT ON INFECTIONS AND WASTE
Authors: Wong Joanne , Sutherland Adam 
Published: August 2016

AimKetamine is used for post-operative analgesia. There has been recent disruption in it's supply. It is usually prescribed by patient's weight (3 mg/kg in 50 ml 0.9% saline) at a rate of 1–5 ml/hr (1–5 microgram/kg/minute). To conserve ketamine supplies our policy was changed to a concentrated “standardised” concentration of ketamine (250 mg in 50 ml 0.9% sodium chloride) that could be run for a maximum of 72 hrs. There is evidence demonstrating no relationship between duration of infusion and microbiological contamination for 72 hrs.1 2 EPIC 3 guidelines recommend using infusion equipment for 72 hrs3.We carried out a service evaluation to determine if prolonged infusions were with associated infection. We also evaluated the volume of ketamine that was discarded per patient.Method125 patients received ketamine (66 patients 24 hr infusions; 59 patients prolonged infusions.) 24 patients were randomly selected (12 per group). A retrospective chart review was undertaken. Data was collected on: duration of treatment (hrs); indicators of line infection (temperature, white cells, Visual Infusion Phlebitis Score (VIP)); number of syringes administered; volume administered (in ml).ResultsThere were no clinical signs of infection in either cohort. No unexpected infections were reported. Concentrated ketamine ran for an average of 48 hrs per patient. 39.9% fewer syringes were used. Patients on 24 hr infusions received 55.8 ml ketamine and patients on long infusions received 51.5 ml ketamine. The amount of ketamine discarded was reduced by 65%.ConclusionResults should be interpreted with caution as patients had few co-morbidities, and received prophylactic antibiotics for surgery. These results suggest however that the risk of infusions running longer than 24 hrs is overstated. Our results raise important questions about the 24 hr expiry imposed on IV infusions. Further research on colonisation of ward-prepared infusions is needed.
CHANGING PRESCRIBING CULTURE – A FOCUS ON CODEINE POSTPARTUM
Authors: Al-Adhami Noor , Whitfield Karen , North Angela 
Published: August 2016

AimTo eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1
MethodsThe evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff.ResultsThe evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2
▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data–probably compatible) to L4 (limited data–possibly hazardous).3
Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their ‘as required’ analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication charts for postpartum women (less than 5%). Those that are prescribed are ceased once highlighted to medical staff. The obstetric pharmacist now presents a session on postpartum analgesia at every new resident medical officer orientation outlining suitable medications to prescribe. In addition all new pharmacists to the women's and new born's team receive training about postpartum analgesia.ConclusionThis study highlights the impact that can be achieved when health care professionals work together to change the culture and prescribing habits in a hospital setting, to enhance patient safety. Evaluating the evidence and presenting to stakeholders as well as providing ongoing training and education to medical, nursing and pharmacy staff are all essential to a successful outcome.
INTER-INDIVIDUAL VARIATION IN THEOPHYLLINE CLEARANCE IN CHILDREN
Authors: Altamimi Mohammed , Choonara Imti , Sammons Helen 
Published: August 2016

BackgroundInter-individual variation in pharmacokinetics in children is an area where there has been little research. We wished to determine the extent of inter-individual variation in the clearance of theophylline in paediatric patients of different ages.MethodsA systematic literature review was performed using the following databases; Embase (1974 to January 2013), Medline (1946 to January 2013), CINAHL (1937 to January 2013), International Pharmaceutical Abstracts (1970 to January 2013) and the Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined.ResultsA total of 56 articles reporting on 1,315 patients met our inclusion criteria. Twenty six studies gave individual data. The majority of the studies were in critically ill patients. Inter-individual variation was a major problem in all age groups. The CV was 9–93% in preterm neonates, 20–97% in term neonates, 18–52% in infants, 2–72% in children and 4.5–43% in adolescents. The mean clearance was higher in children (0.85 to 2 ml/min/kg) than in neonates (0.24 to 0.6 ml/min/kg).ConclusionsLarge inter-individual variation was seen, especially in critically ill patients. Inter-individual variation was higher in neonates than children and adolescents.