Quantification of Dosimetry Improvement With or Without Patient Surface Guidance.

Purpose: Noncoplanar beams and arcs are routinely used to improve dosimetry for intracranial cases, but their application for extracranial cases has been hampered by the risk of collision. This has led to conservative beam selection whose impact on plan dosimetry has not been previously studied. Methods and Materials: A full-body 3-dimensional patient surface was acquired using optical cameras for a single lung patient at the time of computed tomography simulation. Eight stereotactic body radiation therapy (SBRT) plans were created for the patient, with varying degrees of noncoplanarity and deliverability. The plans included volumetric modulated arc therapy and intensity modulated radiation therapy (IMRT) plans ranging from simple, coplanar arcs to multiple noncoplanar arcs and IMRT beams. A total of 70 fields were created across the 8 plans, of which 21 fields were undeliverable with a 5-cm buffer. Organs-at-risk (OARs) metrics including R50, Dmax 2 cm from the PTV, lung V20, and chest wall V30 were evaluated. Five expert SBRT dosimetrists from 5 institutions evaluated field deliverability, with or without the guidance of the clearance map. Results: In the dosimetry evaluation, a clear trend in increasing dosimetric compactness and OAR sparing is observed with increasing plan noncoplanarity. R50, Dmax 2 cm, lung V20, and chest wall V30 decreased 41%, 39%, 43%, and 57%, respectively, from plan 1 (2 coplanar partial arcs) to plan 8 (19 noncoplanar IMRT beams). In the observer tests, the expert dosimetrists' ability to accurately discern beam deliverability because of collision significantly increases with the clearance map. The errors in predicting colliding fields were eliminated using the whole-body surface and clearance map, and the user was able to select fields based on plan quality and patient comfort instead of being overly conservative. Conclusion: The study shows that incorporating a personalized, whole-body clearance map in the treatment planning workflow can facilitate the adoption of noncoplanar beams or arcs that benefit the SBRT plan dosimetry.

Rape Victims' Perceptions of Quality of Encounters With the Swedish Police.

This study focused on raped women's perceptions of their encounters with Swedish police, with a specific focus on quality of encounters, trust, questions asked during police interviews, and perceptions of justice. One hundred and six rape victims, 74 of whom had reported to the police, answered a web-based questionnaire. Results show that where officers explained their line of questioning the perceived intrusiveness of the questioning was lower, as was the level of perceived victim-blaming. Higher quality police encounters were associated with higher trust in the legal system and in police work, and with higher levels of received justice. Findings highlight the importance of trauma-informed policing as a response to sexual assault and provide insights which might help inform policy and practice developments, both in Sweden and more generally.

The Impacts of Conservatism, Social Dominance, and Rape Myth Acceptance on Blame Attribution in Ambiguous Rape Scenarios.

Participants (N = 496) reviewed an ambiguous rape scenario involving a "perpetrator," either in a high or low authority position, and a "victim," who had or had not consumed alcohol. They indicated whether they viewed what happened as rape, and rated the perceived responsibility of the individuals involved. They also completed Conservatism and Rape Myth Acceptance (RMA) scales. Most believed the scenario to constitute rape. Perpetrator responsibility ratings were highest in the high-authority condition, and victims were assigned greater responsibility when they had consumed alcohol. Those who scored higher on the Conservatism/RMA scale attributed less responsibility to the perpetrator and more responsibility to the victim across all conditions.

Urine Residual Volume in Normal Dogs Determined by Direct Measurement and Comparison to Two-Dimensional Ultrasonographic Measurement.

Normal urine residual volume (URV) in dogs has not previously been established by direct measurement. Twenty-two client-owned normal healthy dogs (8 female spayed, 12 male castrated, 2 male intact) without history of urinary abnormalities were included. Dogs were walked outside for 5 min to allow for natural voiding, immediately followed by urinary bladder ultrasound and urinary catheterization. The URV was recorded, and the ultrasound images were used to estimate URV for each dog. There was no significant difference between male and female URV; therefore, all data were pooled. With a 90% confidence interval, URV was 0-0.47 mL/kg with a mean URV of 0.21 mL/kg and a median value of 0.175 mL/kg. There was no significant difference between the measured URV and the ultrasound-determined URV. This case series supports previously established normal URV in the dog; however, a reference interval based on a larger population of dogs with further evaluation of body size/weight, sex, and neuter status is recommended to be established for use in clinical setting to differentiate normal urination from urinary retention in patients.

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study.

​OBJECTIVES: Emergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level. ​DESIGN: This is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland. ​SETTING: 24 public hospitals providing EAS services. ​PARTICIPANTS AND INTERVENTIONS: Patients undergoing EAS as identified by primary procedure codes during the period 2014-2018. ​MAIN OUTCOME MEASURES: The main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250-449) and high (450+) volume and surgical teams with low (<30), medium (30-59) and high (60+) volume during the study period were also estimated. ​RESULTS: The study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals. ​CONCLUSION: Patients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

What influences self-perceived competence and confidence in dementia care home staff? A systematic review.

BACKGROUND: Dementia care staff working in long-term care settings are often exposed to a variety of complex situations that can be emotionally challenging, and a lack of adequate support and limited training opportunities may contribute to high levels of staff turnover in this area. Good-quality training may be beneficial for improving the quality of care provided, and in improving staff confidence and morale. This systematic review aimed to establish how dementia care home staff perceived their own competence and confidence in relation to the care they deliver, whether there are any specific interventions that improve these feelings, and whether feeling more competent and confident impacts on care delivery. METHOD: A search of the literature focusing on staff perceptions of competence and confidence identified 14 873 studies. Following the removal of duplicates and papers that did not meet the inclusion criteria, 19 studies were included in the review and subject to quality assessment. RESULTS: Studies varied in terms of quality and design, and were categorised as either intervention or non-intervention studies. Four studies found a significant increase in feelings of competence and confidence following intervention, although many studies did not statistically analyze their data. The most successful interventions seemed to be those that involved practical support alongside education, and non-intervention studies highlighted the importance of specific dementia and palliative care training with regard to feelings of competence and confidence. CONCLUSION: Teaching alone may not be an adequate method of training dementia care staff, and the most successful interventions were those where practical support was also provided. Most studies suggested that improvements in competence and confidence also had benefits for care delivery and staff wellbeing. More research needs to be done using validated outcome measures and with competence and confidence as the primary aim.

Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions.

ABSTRACTObjective:The aim of this study was to update the literature on interventions for carers of people with dementia published between 2006 and 2016 and evaluate the efficacy of psychoeducational programs and psychotherapeutic interventions on key mental health outcomes (depression, anxiety, burden, and quality of life). METHODS: A meta-analysis was carried out of randomized controlled trials of carer interventions using MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials. RESULTS: The majority of studies were conducted in Western and Southern Europe or the United States and recruited carers of people with Alzheimer's disease or dementia grouped as a whole. The most commonly used outcome measures were depression and burden across studies. The updated evidence suggested that psychoeducation-skill building interventions delivered face-to-face can better impact on burden. Psychotherapeutic interventions underpinned by Cognitive Behavior Therapy (CBT) models demonstrated strong empirical support for treating anxiety and depression and these effects were not affected by the mode of delivery (i.e. face-to-face vs. technology). A modern CBT approach, Acceptance and Commitment Therapy (ACT), seemed to be particularly beneficial for carers experiencing high levels of anxiety. CONCLUSIONS: Future research needs to explore the efficacy of interventions on multiple clinical outcomes and which combination of interventions (components) would have the most significant effects when using CBT. The generalization of treatment effects in different countries and carers of different types of dementia also need to be addressed. More research is needed to test the efficacy of modern forms of CBT, such as ACT.

Elective ambulatory surgical care in Ireland-why it needs to be better coded, classified and managed.

BACKGROUND: In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and efficient setting. AIMS: We set out to sub-classify the different elective surgical day cases treated in Irish public hospitals in order to assess their need to be managed as day cases and the consistency of practice between hospitals. METHODS: We analysed all elective day cases that came under the care of surgeons between January 2014 and December 2016 and sub-classified them into those that were (A) true day case surgical procedures; (B) minor surgery or outpatient procedures; (C) gastrointestinal endoscopies; (D) day case, non-surgical interventions and (E) unclassified or having no primary procedure identified. RESULTS: Of 813,236 day case surgical interventions performed over 3 years, 26% were adjudged to accord with group A, 41% with B, 23% with C, 5% with D and 5% with E. The ratio of A to B procedures did not vary significantly across the range of hospital types. However, there were some notable variations in coding and practices between hospitals. CONCLUSION: Our findings show that many day cases should have been performed as outpatient procedures and that there were variations in coding and practices between hospitals that could not be easily explained. Outpatient procedure coding and a better, more consistent, classification of day cases are both required to better manage this group of patients.

SUSCEPTIBILITY ARTIFACTS ON T2*-WEIGHTED MAGNETIC RESONANCE IMAGING OF THE CANINE AND FELINE SPINE.

The T2*-weighted gradient recalled echo sequence is a sensitive means to detect blood degradation products. While not a routine sequence in magnetic resonance imaging of the spine in small animals, it can provide additional valuable information in select cases. The goal of this retrospective, cross-sectional study was to describe findings when acquiring this sequence during magnetic resonance imaging examination of the spine in small animals. The University of Tennessee's veterinary radiology database was searched for dogs and cats that underwent magnetic resonance imaging for suspect spinal disease in which a T2*-weighted gradient recalled echo sequence was acquired and susceptibility artifact was identified. The following information was recorded: signalment, clinical signs, location and appearance of susceptibility artifact, and final diagnosis. Thirty-nine cases were included in the study. Extradural susceptibility artifacts were observed in cases of intervertebral disc herniation with or without associated hemorrhage (n = 28), extradural hemorrhage associated with spinal trauma (n = 2), hemophilia (n = 1), and in a cystic extradural mass (n = 1). Remaining lesions displaying susceptibility artifact were intramedullary and included presumptive acute noncompressive nucleus pulposus extrusion (n = 2), hematoma (n = 1), hemangiosarcoma metastasis (n = 1), intramedullary disc extrusion (n = 1), presumptive meningomyelitis (n = 1), and a mass of undetermined etiology (n = 1). Inclusion of a T2*-weighted gradient recalled echo sequence may be helpful in spinal magnetic resonance imaging when standard imaging sequences are ambiguous or intramedullary lesions are observed.

Cognitive bias in line-up identifications: the impact of administrator knowledge.

Prior knowledge of the likely or expected outcome of a forensic investigation has been shown to produce biases in the results obtained, reducing objectivity. The wide prevalence of such cognitive biases in many judgments has long been recognised by social psychologists, but its importance is only now gaining appreciation within forensic science communities. It is therefore timely to draw attention to the power of cognitive biases found in a study of the influence of administrator expectations on photographic identifications. Data are presented to show that when a line-up administrator knows the identity and position of a target within a line-up choice, in which the 'witness' is ignorant of the actual target, that target is more than twice as likely to be selected compared with when the administrator is kept 'blind'. These findings, taken together with related studies, support the recommendation that all forensic analyses are made 'double-blind'-a method that has proven to be effective in reducing such effects within the social sciences.

A "silent" nucleotide substitution in exon 4 is responsible for the "alternative expression" of HLA-A*01:01:38L through aberrant splicing.

A Welsh Bone Marrow Donor Registry donor was serologically typed, using both alloantisera and monoclonal antibodies, as human leukocyte antigen (HLA)-A2, A-, but typed by polymerase chain reaction sequence-specific priming as HLA-A*01, A*02. Full gene sequencing of the A*01 separated allele indicated an apparently normal A*01:01:01:01 apart from a silent change at nucleotide 705 in exon 4, codon 211 (alanine: normally GCG but GCA in this donor). Sequence analysis of the amplified A*01 allele in cDNA synthesized from RNA indicated that exons 1, 2, 3, and 5 had typical A*01:01 sequences. However, exon 4 was truncated in this allele (87 nucleotides shorter), beginning just after the single nucleotide polymorphism (SNP) identified in genomic DNA sequencing. The nucleotide sequence up to, and 1 nucleotide after, the SNP is homologous with the 3' end of human leukocyte antigen (HLA)-A intron 3 and thus resembles a splice site. However, a small amount of "normal" HLA-A1 was detected on the surface of cells from an Epstein-Barr virus transformed B-cell line (BCL), but not on peripheral blood mononuclear cells, by flow cytometry. Additionally, a trace amount of "normal sized" A*01 was amplified from cDNA. We suggest that in this A*01 variant allele (A*01:01:38L) intron 3 is largely spliced out with a part of exon 4; exon 4 is still in-frame but the protein is smaller than the wild type. This is likely to affect folding and assembly of the "wild type" mature protein on the cell surface, thus explaining the apparent null phenotype when assayed by conventional serology. However, a small amount of A1 protein is made from correctly spliced A*01 mRNA and is detectable on BCLs using flow cytometry.

Advanced technology for storage and transport of purified DNA from umbilical cord blood prior to use in human leukocyte antigens typing and whole-genome microarray analysis.

Two technologies for dry-state, ambient temperature transport of biospecimens were evaluated in this study. Umbilical cord blood (UCB) samples from 4 individuals were transported at ambient temperature using GenPlates, and the DNA recovered was compared with DNA purified directly from granulocytes of the same UCB samples. GenTegra™ DNA tubes were then used to transport the DNA from California to North Carolina and New Zealand, either immediately after drying or following 30 days of storage at 25°C and 76°C. The integrity of the recovered DNA was thoroughly tested using 2 human leukocyte antigens (HLA)-typing techniques (bead array and sequencing), as well as microarray-based whole-genome scanning. HLA-typing results were the same for all samples whether the DNA had been stored for 3 days during transport or 30 days at either 25°C or 76°C. There were no differences in the HLA-typing results of DNA recovered from UCB samples stored in GenPlates compared with DNA extracted directly from granulocytes. Moreover, the microarray analysis revealed call rates of >99.5% for every sample, regardless of storage method, with a statistical concordance of 99.99% between the UCB samples stored in GenPlates compared with DNA extracted directly from granulocytes. These results indicate that both GenPlates and GenTegra are viable methods of storing and transporting UCB (stem cell) biospecimens in a dry state. The quality and quantity of DNA recovered using both technologies are sufficient for complex genotyping using a number of different methods.

A cascade of disparities: health and health care access for people with intellectual disabilities.

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.

The Ethiopian crisis of 1999-2000: lessons learned, questions unanswered.

During 1999-2000, Ethiopia was brought to the edge of a major disaster, with some 10 million people estimated to be in need offood assistance at the height of the crisis. A repeat of the catastrophic famine of 1984-5 was avoided, but the numbers of people affected, the loss of life and the destruction of livelihoods made this one of the most serious crises in the Horn of Africa in the past 15 years. The humanitarian community has been slow to recognise the lessons of 1999-2000, and there have been surprisingly few attempts to conduct a serious, post-event evaluation of the overall crisis and response. The label famine averted' seems to summarise the crisis to the satisfaction of most parties involved. This paper reviews the crisis, the events that led up to it and the response effort. It examines thefactors that contributed to making this crisis so serious, in order to draw conclusions and note issues that are relevant to current thinking about disaster preparedness and response - in Ethiopia and elsewhere. Some of the lessons learned from the 1999-2000 crisis are not new. However, the veryfact that mistakes have been repeated should be a lesson to the humanitarian community.