An IAEA survey of radiotherapy practice including quality assurance extent and depth.

Background: The IAEA recommends a quality assurance program in radiotherapy to ensure safe and effective treatments. In this study, radiotherapy departments were surveyed on their current practice including the extent and depth of quality assurance activities.Methods: Radiotherapy departments were voluntarily surveyed in three stages, firstly, in basic facility information, secondly, in quality assurance activities and treatment techniques, and thirdly, in a snapshot of quality assurance, departmental and treatment activities.Results: The IAEA received completed surveys from 381 radiotherapy departments throughout the world with 100 radiotherapy departments completing all three surveys. Dominant patterns were found in linac-based radiotherapy with access to treatment planning systems for 3D-CRT and 3D imaging. Staffing levels for major staff groups were on average in the range recommended by the IAEA. The modal patient workload per EBRT unit was as expected in the range of 21-30 patients per day, however significant instances of high workload (more than 50 patients per day per treatment unit) were reported. Staffing levels were found to correlate with amount of treatment equipment and patient workload. In a self-assessment of quality assurance performance, most radiotherapy departments reported that they would perform at least 60% of the quality assurance activities itemized in the second survey, with particular strength in equipment quality control. In a snapshot survey of quality assurance performance, again equipment quality control practice was well developed, particularly for the treatment equipment.Conclusions: The IAEA surveys provide a snapshot of current radiotherapy practice including quality assurance activities.

An experimental study on using a diagnostic computed radiography system as a quality assurance tool in radiotherapy.

The advent of improved digital imaging modalities in diagnostic and therapy is fast making conventional films a nonexistent entity. However, several radiotherapy centers still persist with film for performing quality assurance (QA) tests. This paper investigates the feasibility of using a diagnostic computed radiography (CR) system as a QA tool in radiotherapy. QA tests such as light field congruence, field size verification, determination of radiation isocentre size, multileaf collimator (MLC) check and determination of isocentric shift for stereotactic radiosurgery (SRS) were performed and compared with film. The maximum variation observed between CR and film was 0.4 mm for field size verification, -0.13 mm for the radiation isocentre size check, 0.77 for MLC check and -0.1 mm for isocentric shift using the Winston Lutz test tool for SRS QA. From these results obtained with the CR it is concluded that a diagnostic CR system can be an excellent cost-effective digital alternative to therapy film as a tool for QA in radiotherapy.

Repeated praziquantel treatments remodel the genetic and spatial landscape of schistosomiasis risk and transmission.

Repeated treatments with praziquantel reduce schistosomiasis prevalence and morbidity, but transmission persists and populations often recover within a few years. To identify factors associated with persistence, we surveyed and treated all identified Schistosoma mansoni infections in two rural Brazilian communities (Jenipapo and Volta do Rio) in 2009, 2012 and 2013. Eggs were collected from all infected individuals and genotyped with 11 microsatellite markers to evaluate parasite differentiation and diversity. After successive rounds of community-wide treatment, prevalence decreased from 45% to 24% then 16%. Intensity of infection decreased by 57% over this period, and the number of eggs transmitted to the environment decreased by 92%. During all time periods the majority of eggs were excreted by those >15years of age. The incidence was 23% in 2012 and 15% in 2013, consistent with a decrease in transmission. There was little immigration or gene flow over a distance of 6km. On reinfection, infrapopulations were moderately differentiated indicating that pretreatment multilocus genotypes were not fully reacquired. The effective population size responded to census population decline more rapidly than differentiation. Reinfection was concentrated in the downstream portion of Jenipapo, consistent with the observed increased human fecal contamination. At this scale and in this area S. mansoni infections exist on a fragmented landscape with a highly focal pattern of transmission that may facilitate future elimination.

The relative contribution of immigration or local increase for persistence of urban schistosomiasis in Salvador, Bahia, Brazil.

Urbanization is increasing across the globe, and diseases once considered rural can now be found in urban areas due to the migration of populations from rural endemic areas, local transmission within the city, or a combination of factors. We investigated the epidemiologic characteristics of urban immigrants and natives living in a neighborhood of Salvador, Brazil where there is a focus of transmission of Schistosoma mansoni. In a cross-sectional study, all inhabitants from 3 sections of the community were interviewed and examined. In order to determine the degree of parasite differentiation between immigrants and the native born, S. mansoni eggs from stools were genotyped for 15 microsatellite markers. The area received migrants from all over the state, but most infected children had never been outside of the city, and infected snails were present at water contact sites. Other epidemiologic features suggested immigration contributed little to the presence of infection. The intensity and prevalence of infection were the same for immigrants and natives when adjusted for age, and length of immigrant residence in the community was positively associated with prevalence of infection. The population structure of the parasites also supported that the contribution from immigration was small, since the host-to-host differentiation was no greater in the urban parasite population than a rural population with little distant immigration, and there had been little differentiation in the urban population over the past 7 years. Public health efforts should focus on eliminating local transmission, and once eliminated, reintroduction from distant migration is unlikely.

Effect of a low-tryptophan diet as an adjuvant to conventional neuroleptic therapy in schizophrenia.

Eleven patients with DSM-III-R schizophrenia were entered into a 4-day tryptophan (TRP)-deficient diet. The diet lowered total plasma TRP levels in all patients; during the diet phase, there was a greater than 50% reduction in mean total plasma TRP levels from the pre-diet phase. The low-TRP diet improved performance on the Stroop Color and Word Test. These data are especially intriguing in view of the suggestion that a deficit in color-word naming is related to frontal lobe dysfunction and the possible occurrence of frontal lobe abnormalities in patients with schizophrenia. Interestingly, depressive symptomatology did not emerge on the TRP-deficient diet, despite the lowering of total plasma TRP levels. There were statistically significant improvements noted on objective ratings of the severity of psychotic symptomatology; however, these statistical improvements were without obvious clinical significance, as the magnitude of the changes on the behavioral ratings were minimal. The results of this study suggest that there might be some adjuvant potential for a low-TRP diet in the treatment of schizophrenia, and that schizophrenia or antipsychotic medications might offer some protection against the depressive effects of a TRP-deficient diet.

Myopathy in guinea pigs.

Myopathy resembling nutritional muscular dystrophy occurred in a colony of 150 guinea pigs. Of 54 animals affected, 27 died. Major clinical signs were depression, conjunctivitis, and reluctance to move. Lesions were widespread throughout skeletal and cardiac musculature. Clinical signs and deaths ceased when the diet was changed to a different commercial ration. A single intramuscular injection of sodium selenite and alphatocopherol brought prompt remission of clinical signs in one group of 20 so treated.

Effects of caging type and animal source on the development of foot lesions in Sprague Dawley rats (Rattus norvegicus).

Retrospective analysis of data from a chronic (2-year) rat (Rattus norvegicus) carcinogenicity study was performed to compare the incidence of foot lesion development relative to cage type and animal supplier. Groups of rats from two different suppliers were housed in wire-bottom or polycarbonate cages. Clinical observations and body weights were collected. Data were analyzed to determine foot lesion occurrence, time to onset of foot lesions, and body weight change over time. Noteworthy abnormalities of the plantar surface of the hind foot (i.e., ulcers or nodular swellings) were more common in heavier rats than in lighter animals of the same sex (but different source), and abnormalities were more common in rats housed in wire cages than polycarbonate cages. However, despite differences in weight, cage type, and supplier, lesions were not found until the rats had been housed for more than 1 year.

The survival and growth of Bacillus cereus in boiled and fried rice in relation to outbreaks of food poisoning.

A number of outbreaks of food poisoning attributed to Bacillus cereus have been reported recently and all have been associated with cooked rice usually from Chinese restaurants and ;take-away' shops.Tests were made to assess the heat resistance of B. cereus spores in aqueous suspension, the growth of the organism in boiled rice stored at temperatures in the range 4-55 degrees C., and the effect of cooking and storage on the growth of the organism in boiled and fried rice. The spores of B. cereus survived cooking and were capable of germination and outgrowth. The optimum temperature for growth in boiled rice was between 30 degrees and 37 degrees C. and growth also occurred during storage at 15 degrees and 43 degrees C.To prevent further outbreaks it is suggested that rice should be boiled in smaller quantities on several occasions during the day, thereby reducing the storage time before frying. After boiling the rice should either be kept hot (> 63 degrees C.) or cooled quickly and transferred to a refrigerator within 2 hr. of cooking. Boiled or fried rice must not be stored under warm conditions especially in the range 15-50 degrees C.

Comparative analysis of the 16S rRNA gene sequence of the putative agent of proliferative ileitis of hamsters.

Proliferative ileitis of hamsters is consistently associated with the presence of intracellular bacteria in affected ileal epithelial cells. The 16S rRNA gene sequence of the putative etiologic agent of proliferative ileitis was determined by using cell culture-maintained organisms. The highest level of relatedness (98.4%) was observed with a newly described obligately intracellular bacterium obtained from porcine intestines, and the level of homology with Desulfovibrio desulfuricans was 87.5%.