Incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infection in European hospitals: the COMBACTE-NET ARTHR-IS multi-centre study.

BACKGROUND: The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. METHODS: This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. RESULTS: The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. CONCLUSIONS: This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.

BNCT research activities at the Granada group and the project NeMeSis: Neutrons for medicine and sciences, towards an accelerator-based facility for new BNCT therapies, medical isotope production and other scientific neutron applications.

The Granada group in BNCT research is currently performing studies on: nuclear and radiobiological data for BNCT, new boron compounds and a new design for a neutron source for BNCT and other applications, including the production of medical radioisotopes. All these activities are described in this report.

Exploring neutron capture therapy with 33S and 10B.

The 33S(n,α)30Si reaction was proposed as cooperative neutron capturer to 10B(n,α)7Li in Neutron Capture Therapy (NCT). At that moment, the available 33S(n,α)30Si cross-section data were scarce and discrepant in key energy ranges for its use in NCT. Since then, three experiments have been carried out at n_TOF facility at CERN and at Institut Laue-Langevin. These new data are used for the calculation of the dose rate on ICRU-4 tissue by using kerma factors, a simplified model of tissue and a 13.45 keV neutron beam, energy of the most important 33S(n,α)30Si resonance. A significant enhancement of the dose rate due to the presence of 33S is shown. In spite of the limitations, the cooperative action of 33S and 10B is an interesting possibility to be studied for accelerator-based neutron sources with non-moderated neutrons.

CHARACTERIZATION OF THE EPITHERMAL NEUTRON FIELD PRODUCED BY p+7Li REACTION IN A TANDEM ACCELERATOR USING A BONNER SPHERE SPECTROMETER.

The proton beam produced in the Nuclear Physics line of the tandem accelerator of the Centro Nacional de Aceleradores was used to generate a neutron field. In particular, 1.912 MeV protons were used to produce well-known epithermal neutrons through the p+7Li → n+7Be reaction. The aim of the work was to characterize this field while testing the performance of a Bonner sphere spectrometer in the epithermal range. Measurements were performed in four locations at different angle (0°, 30°, 60° and 90°) from beam incidence direction in order to study the angular dependence of the field. Both a parametric and numerical unfolding methods were tested to process the counts of the central detectors and obtain the energy distribution of the neutron fluence. In addition, a Monte Carlo simulation was carried out to complete the study and provide a guess spectrum for numerical unfolding. It was found that the fluence rate and mean energy decrease as the angle from beam direction increases. Total fluence was 2.75, 1.36, 0.366 and 0.216 cm-2 per charge collected in the target at 0°, 30°, 60° and 90°, respectively. Mean energy of the field ranges from 46 to 17 keV at 0° and 60°, respectively. In all cases, given that the irradiation room is so large, the contribution of thermal neutrons to the field is small. Regarding the unfolding, the total fluences estimated by all methods were in agreement within the uncertainties.

DOSE EFFECT OF THE 33S(n,α) 30SI REACTION IN BNCT USING THE NEW n_TOF-CERN DATA.

33S is a stable isotope of sulphur which is being studied as a potential cooperative target for Boron Neutron Capture Therapy (BNCT) in accelerator-based neutron sources because of its large (n,α) cross section in the epithermal neutron energy range. Previous measurements resolved the resonances with a discrepant description of the lowest-lying and strongest one (at 13.5 keV). However, the evaluations of the major databases do not include resonances, except EAF-2010 which shows smaller values in this range than the experimental data. Furthermore, the glaring lack of data below 10 keV down to thermal (25.3 meV) has motivated a new measurement at n_TOF at CERN in order to cover the whole energy range. The inclusion of this new 33S(n,α) cross section in Monte Carlo simulations provides a more accurate estimation of the deposited kerma rate in tissue due to the presence of 33S. The results of those simulations represent the goal of this work.

Using a Tandem Pelletron accelerator to produce a thermal neutron beam for detector testing purposes.

Active thermal neutron detectors are used in a wide range of measuring devices in medicine, industry and research. For many applications, the long-term stability of these devices is crucial, so that very well controlled neutron fields are needed to perform calibrations and repeatability tests. A way to achieve such reference neutron fields, relying on a 3 MV Tandem Pelletron accelerator available at the CNA (Seville, Spain), is reported here. This paper shows thermal neutron field production and reproducibility characteristics over few days.

(33)S as a cooperative capturer for BNCT.

(33)S is a stable isotope of sulfur for which the emission of an α-particle is the dominant exit channel for neutron-induced reactions. In this work the enhancement of both the absorbed and the equivalent biologically weighted dose in a BNCT treatment with 13.5keV neutrons, due to the presence of (33)S, has been tested by means of Monte Carlo simulations. The kerma-fluence factors for the ICRU-4 tissue have been calculated using standard weighting factors. The simulations depend crucially on the scarce (33)S(n,α)(30)Si cross-section data. The presence of a high resonance at 13.5keV was established by previous authors providing discrepant resonance parameters. No experimental data below 10keV are available. All of this has motivated a proposal of experiment at the n_TOF facility at CERN. A setup was designed and tested in 2011. Some results of the successful test will be shown. The experiment is scheduled for the period November to December 2012.

Temperature-tuned Maxwell-Boltzmann neutron spectra for kT ranging from 30 up to 50 keV for nuclear astrophysics studies.

The need of neutron capture cross section measurements for astrophysics motivates present work, where calculations to generate stellar neutron spectra at different temperatures are performed. The accelerator-based (7)Li(p,n)(7)Be reaction is used. Shaping the proton beam energy and the sample covering a specific solid angle, neutron activation for measuring stellar-averaged capture cross section can be done. High-quality Maxwell-Boltzmann neutron spectra are predicted. Assuming a general behavior of the neutron capture cross section a weighted fit of the spectrum to Maxwell-Boltzmann distributions is successfully introduced.