[18]F-fluoroethyl-l-tyrosine positron emission tomography for radiotherapy target delineation: Results from a Radiation Oncology credentialing program.

Background and purpose: The [18]F-fluoroethyl-l-tyrosine (FET) PET in Glioblastoma (FIG) study is an Australian prospective, multi-centre trial evaluating FET PET for newly diagnosed glioblastoma management. The Radiation Oncology credentialing program aimed to assess the feasibility in Radiation Oncologist (RO) derivation of standard-of-care target volumes (TVMR) and hybrid target volumes (TVMR+FET) incorporating pre-defined FET PET biological tumour volumes (BTVs). Materials and methods: Central review and analysis of TVMR and TVMR+FET was undertaken across three benchmarking cases. BTVs were pre-defined by a sole nuclear medicine expert. Intraclass correlation coefficient (ICC) confidence intervals (CIs) evaluated volume agreement. RO contour spatial and boundary agreement were evaluated (Dice similarity coefficient [DSC], Jaccard index [JAC], overlap volume [OV], Hausdorff distance [HD] and mean absolute surface distance [MASD]). Dose plan generation (one case per site) was assessed. Results: Data from 19 ROs across 10 trial sites (54 initial submissions, 8 resubmissions requested, 4 conditional passes) was assessed with an initial pass rate of 77.8 %; all resubmissions passed. TVMR+FET were significantly larger than TVMR (p < 0.001) for all cases. RO gross tumour volume (GTV) agreement was moderate-to-excellent for GTVMR (ICC = 0.910; 95 % CI, 0.708-0.997) and good-to-excellent for GTVMR+FET (ICC = 0.965; 95 % CI, 0.871-0.999). GTVMR+FET showed greater spatial overlap and boundary agreement compared to GTVMR. For the clinical target volume (CTV), CTVMR+FET showed lower average boundary agreement versus CTVMR (MASD: 1.73 mm vs. 1.61 mm, p = 0.042). All sites passed the planning exercise. Conclusions: The credentialing program demonstrated feasibility in successful credentialing of 19 ROs across 10 sites, increasing national expertise in TVMR+FET delineation.

Multisite Quality Improvement Program Within the Project ECHO Diabetes Remote Network.

BACKGROUND: The telementoring Project ECHO (Extension for Community Healthcare Outcomes) model has been shown to improve disease management in diabetes in many underserved communities. The authors aim to evaluate if ECHO could also be an effective tool for quality improvement (QI) of diabetes care in these communities. METHODS: Thirteen clinics in underserved communities in California and Florida participating in Project ECHO Diabetes were recruited for a 12-month QI program. The program provided weekly tele-education sessions, including a didactic presentation and case-based discussion. In addition, clinics chose their own set of quality measures to improve and met remotely to discuss their efforts, successes, and setbacks every quarter with mentorship from QI experts. RESULTS: Of the 31 QI initiatives attempted by different clinics, all had either made improvements (25 initiatives, 80.6%) or were in the process of making improvements (6 initiatives, 19.4%) in structural, process, and outcome measures. Examples of these measures include whether clinics have protocols to identify high-risk patients (structure), numbers of continuous glucose monitor prescriptions submitted by the clinics (process), and percentage of patients with diabetes whose most recent HbA1c are > 9% (outcome). For one measure, 40.0% of the clinics had achieved a higher percentage of cumulative HbA1c measurement in the third quarter of the year, compared to the fourth quarter in the previous year. The cost of QI implementation varied widely due to different number of personnel involved across sites. CONCLUSION: A QI program delivered via Project ECHO Diabetes can facilitate quality improvements in underserved communities.

Sleep Patterns in Young Children with Congenital Heart Disease.

Sleep patterns of 419 toddlers with congenital heart disease were comparable with the normative population except for increased likelihood across the cohort of sleeping in parents' room and increased disrupted sleep in children aged 18-23 months. Disrupted sleep patterns were associated with lower maternal education and increased medical complexity.

Cometabolism of Chlorinated Volatile Organic Compounds and 1,4-Dioxane in Groundwater.

This article provides an overview of the bioremediation of groundwater plumes containing admixtures of chlorinated volatile organic compounds (CVOCs) and 1,4-dioxane. The remediation of these plumes has historically focused on the reductive dechlorination of the CVOCs. Many of the remaining plumes are relatively large, and contaminant concentrations are diluted below the concentrations that can sustain reductive dechlorination. Cometabolic processes can decrease contaminant concentrations below the thresholds needed to support direct metabolism but typically require the addition of a substrate, such as high-purity propane. Relatively intensive site characterization and monitoring is necessary to implement bioremediation.

Local Temporal Regularities in Child-Directed Speech in Spanish.

PURPOSE: The purpose of this study is to characterize the local (utterance-level) temporal regularities of child-directed speech (CDS) that might facilitate phonological development in Spanish, classically termed a syllable-timed language. METHOD: Eighteen female adults addressed their 4-year-old children versus other adults spontaneously and also read aloud (CDS vs. adult-directed speech [ADS]). We compared CDS and ADS speech productions using a spectrotemporal model (Leong & Goswami, 2015), obtaining three temporal metrics: (a) distribution of modulation energy, (b) temporal regularity of stressed syllables, and (c) syllable rate. RESULTS: CDS was characterized by (a) significantly greater modulation energy in the lower frequencies (0.5-4 Hz), (b) more regular rhythmic occurrence of stressed syllables, and (c) a slower syllable rate than ADS, across both spontaneous and read conditions. DISCUSSION: CDS is characterized by a robust local temporal organization (i.e., within utterances) with amplitude modulation bands aligning with delta and theta electrophysiological frequency bands, respectively, showing greater phase synchronization than in ADS, facilitating parsing of stress units and syllables. These temporal regularities, together with the slower rate of production of CDS, might support the automatic extraction of phonological units in speech and hence support the phonological development of children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21210893.

Management of large dilute plumes of chloroethenes and 1,4-dioxane via monitored natural attenuation (MNA) and MNA augmentation.

Management of large, dilute groundwater plumes of comingled chlorinated volatile organic compounds (CVOCs) and 1,4-dioxane (dioxane) is problematic due to chemical, hydrogeologic and economic concerns. The US Environmental Protection Agency (US EPA) has conducted research on the management of CVOC plumes for many years, and more recently dioxane. US EPA research on monitored natural attenuation (MNA) of CVOC plumes was reviewed by a science advisory board in 2001. Specific additional research was recommended and has been addressed in a series of US EPA reports produced over almost two decades. These reports are summarized in this document along with supporting information including evidence of biological degradation of dioxane. Based on the summarized reports, US EPA work documented elsewhere, and the work of others, under appropriate conditions MNA or augmented MNA remain viable management options for these plumes. Unlike MNA of plumes containing only CVOCs, however, MNA of large dilute comingled plumes should be expected to occur by cometabolic oxidation rather than direct metabolic processes.

Did Myzus persicae (Sulzer) from potato reared on a novel host for 15 years retain its host-related properties?

Myzus persicae (Sulzer) is an important agricultural pest worldwide causing major economic losses due to its ability to transmit over 100 viruses including Potato virus Y (PVY). Myzus persicae shows considerable variation with respect to performance on its host plants. The objective of this study was to use a survival experiment, behavioural observations, including observations of probing and feeding behaviour obtained using the electrical penetration graph (EPG) technique, and a PVY acquisition experiment to determine whether or not potato was still the more suitable host for M. persicae originating on potato and reared on a novel host, table beet, for over 15 years. In a survival experiment, the pre-reproductive period was significantly longer while adult survival and whole longevity were significantly lower for M. persicae reared on beet fed beet leaves compared to M. persicae reared on potato fed potato leaves. The number of progenies produced and fecundity were both significantly reduced (90 and 85%, respectively) for M. persicae reared on beet fed beet leaves. Ethological observations and EPG assessment of M. persicae behaviour reared on beet placed on beet leaves showed significantly impaired behavioural responses compared to M. persicae reared on potato placed on potato leaves. The rate of PVY acquisition was the same for M. persicae reared on beet and on potato. These results indicate that after 15 years on table beet, M. persicae still performs better on its original host, potato, and appears to be a specialized potato-adapted genotype.

'A life I can cope with'. An alternative model of cognitive behavioural therapy (CBT) for CFS/ME.

OBJECTIVES: This study aimed to explore the experience of cognitive behavioural therapy (CBT) aimed at better management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), rather than increasing activity. DESIGN: This was a qualitative study using grounded theory analysis. METHODS: Semi-structured interviews were conducted with 13 adults who had engaged in CBT at a specialist CFS/ME service in which CBT is aimed at improved management of the condition. RESULTS: A model was produced in which participants felt more able to cope with CFS/ME. Reduced fatigue did not seem to be a necessary precondition to managing. This has implications for CBT for CFS/ME. CONCLUSIONS: Specialist CBT for CFS/ME may result in improved coping and reduced distress, independently of changes in fatigue. PATIENT OR PUBLIC CONTRIBUTION: The researcher met with a representative from the university's service user advisory group (SAGE), who had lived experience of CFS/ME. They commented on possible questions for the interview topic guide and provided advice on ways in which ethical issues specific to CFS/ME could be considered, for example, prevention of harm during interviews. Second, for quality assurance as part of respondent validation, a proposed draft of the grounded theory was discussed with participants.

The use of collimator angle optimization and jaw tracking for VMAT-based single-isocenter multiple-target stereotactic radiosurgery for up to six targets in the Varian Eclipse treatment planning system.

PURPOSE: Island blocking occurs in single-isocenter multiple-target (SIMT) stereotactic radiotherapy (SRS) whenever targets share multi-leaf collimator (MLC) leaf pairs. This study investigated the effect on plan quality and delivery, of reducing island blocking through collimator angle optimization (CAO). In addition, the effect of jaw tracking in this context was also investigated. METHODS: For CAO, an algorithm was created that selects the collimator angle resulting in the lowest level of island blocking, for each beam in any given plan. Then, four volume-modulated arc therapy (VMAT) SIMT SRS plans each were generated for 10 retrospective patients: two CAO plans, with and without jaw tracking, and two plans with manually selected collimator angles, with and without jaw tracking. Plans were then assessed and compared using typical quality assurance procedures. RESULTS: There were no substantial differences between plans with and without CAO. Jaw tracking produced statistically significant reduction in low-dose level parameters; healthy brain V10% and mean dose were reduced by 9.66% and 15.58%, respectively. However, quantitative values (108 cc for V10% and 0.35 Gy for mean dose) were relatively small in relation to clinical relevance. Though there were no statistically significant changes in plan deliverability, there was a notable trend of plans with jaw tracking having lower gamma analysis pass rates. CONCLUSION: These findings suggest that CAO has limited benefit in VMAT SIMT SRS of 2-6 targets when using a low-dose penalty to the healthy brain during plan optimization in Eclipse. As clinical benefits of jaw tracking were found to be minimal and plan deliverability was potentially reduced, a cautious approach would be to exclude jaw tracking in SIMT SRS plans.

The degradation of acetaldehyde in estuary waters in Southern California, USA.

Acetaldehyde plays an important role in oxidative cycles in the troposphere. Estimates of its air-water flux are important in global models. Biological degradation is believed to be the dominant loss process in water, but there have been few measurements, none in estuaries. Acetaldehyde degradation rates were measured in surface waters at the inflow to the Upper Newport Back Bay estuary in Orange County, Southern California, USA, over a 6-month period including the rainy winter season. Deuterated acetaldehyde was added to filtered and unfiltered water samples incubated in glass syringes, and its loss analyzed by purge and trap gas chromatography mass spectrometry. Filtered samples showed no significant degradation, suggesting that particle-mediated degradation is the dominant removal process. Correlation between measured degradation rate constants in unfiltered incubations and bacteria counts suggests the loss is due to microorganisms. Degradation in unfiltered samples followed first-order kinetics, with rate constants ranging from 0.0006 to 0.025 min-1 (k; average 0.0043 ± 0.006 min-1). Turnover (1/k) ranged from 40 to 1667 min, consistent with prior studies in coastal waters. Acetaldehyde concentrations in the estuary are estimated to range from 30 to ~500 nM (average ~250 nM). Results suggest the estuary is a source of acetaldehyde to the atmosphere.

Mitigating Damage to Hybrid Perovskites Using Pulsed-Beam TEM.

Using a pulsed-beam transmission electron microscope, we discover a reduction in damage to methylammonium lead iodide (MAPbI3) as compared to conventional beams delivered at the same dose rates. For rates as low as 0.001 e·Å-2·s-1, we find up to a 17% reduction in damage at a total dose of 10 e·Å-2. We systematically study the effects of number of electrons in each pulse and the duration between pulse arrival. Damage increases for both, though the number of electrons per pulse has a larger effect. A crossover is identified, where a pulsed beam causes more damage than a conventional one. Although qualitatively similar to previous findings, the degree to which damage is reduced in MAPbI3 is less than that observed for other materials (e.g., C36H74), supporting the hypothesis that the effects are material- and damage-mechanism-dependent. Despite this, the observation here of damage reduction for relatively large electron packets (up to 200 electrons per pulse) suggests that MAPbI3 is in fact less susceptible to irradiation than C36H74, which may be related to reported self-healing effects. This work provides insights into damage processes and durability in hybrid perovskites and also illustrates the viability of using pulsed-beam TEM to explore the associated molecular-level routes to degradation, analogous to laser-accelerated energetic pulsed electron beams and the study of damage to biomolecules, cells, and tissues in radiobiology.

Technical note: improving the efficiency of generating bovine extraembryonic endoderm cells.

The formation of extraembryonic endoderm (XEN) occurs early in embryonic development. The cell types that develop from the XEN remain poorly studied in ruminant species because of the lack of suitable cell culture model systems. The goal of this work was to establish a protocol for producing XEN cell cultures from bovine blastocysts. Previous work identified fibroblast growth factor 2 (FGF2) as a facilitator of bovine XEN development. Further refinements in culture conditions studied here included exposure to 20% fetal bovine serum and FGF2 replenishment. These modifications yielded an endoderm outgrowth formation incidence of 81.6% ± 5.5% compared with 33.3% ± 5.5% in bovine serum albumin (BSA)-supplemented controls. These cells resembled XEN when examined morphologically and contained XEN transcripts (GATA binding protein 4 [GATA4] and GATA binding protein 6 [GATA6]) as well as transcripts present in visceral (BCL2 interacting protein 1 [BNIP1] and vascular endothelial growth factor A [VEGFA]) and parietal (C-X-C motif chemokine receptor 4 [CXCR4], thrombomodulin [THBD], and hematopoietically expressed homeobox [HHEX]) XEN. Two XEN cell lines were maintained for prolonged culture. Both lines continued to proliferate for approximately 6 wk before becoming senescent. These cultures maintained an XEN-like state and continued to express GATA4 and GATA6 until senescence. An increase in the abundance of visceral and parietal XEN transcripts was observed with continued culture, suggesting that these cells either undergo spontaneous differentiation or retain the ability to form various XEN cell types. Stocks of cultured cells exposed to a freeze-thaw procedure possessed similar phenotypic and genotypic behaviors as nonfrozen cells. To conclude, a procedure for efficient production of primary bovine XEN cell cultures was developed. This new protocol may assist researchers in exploring this overlooked cell type for its roles in nutrient supply during embryogenesis.

Parent Perspectives in Shared Decision-Making for Children With Medical Complexity.

OBJECTIVE: Shared decision-making (SDM) may improve outcomes for children with medical complexity (CMC). CMC have lower rates of SDM than other children, but little is known about how to improve SDM for CMC. The objective of this study is to describe parent perspectives of SDM for CMC and identify opportunities to improve elements of SDM specific to this vulnerable population. METHODS: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English- or Spanish-speaking, with a CMC <12 years old. Interviews were recorded, transcribed, and analyzed by independent coders for shared themes using modified grounded theory. Codes were developed using an iterative process, beginning with open-coding of a subset of transcripts followed by discussion with all team members, and distillation into preliminary codes. Subsequent coding reviews were conducted until no new themes emerged and existing themes were fully explored. RESULTS: We conducted interviews with 32 parents (27 in English, mean parent age 34 years, standard deviation = 7; mean child age 4 years, standard deviation = 4; 50% with household income <$50,000, 47% with low health literacy) in inpatient and outpatient settings. Three categories of themes emerged: participant, knowledge, and context. Key opportunities to improve SDM included: providing a shared decision timeline, purposefully integrating patient preferences and values, and addressing uncertainty in decisions. CONCLUSION: Our results provide insight into parent experiences with SDM for CMC. We identified unique opportunities to improve SDM for CMC that will inform future research and interventions to improve SDM for CMC.

Production of acetaldehyde from ethanol in coastal waters.

Interest in understanding the cycling of ethanol in the environment has grown as ethanol use as a gasoline additive has increased. The production of acetaldehyde from ethanol was measured in Southern California coastal seawater. The rate of increase of acetaldehyde was positively correlated with the rate constant for ethanol biodegradation and bacteria count and was consistent with two consecutive first-order reactions where acetaldehyde is first biologically produced from ethanol then consumed. Correlation with bacteria counts suggested that acetaldehyde degradation was also a biological process. The rate constants for acetaldehyde production from ethanol and acetaldehyde loss averaged 3.0 ± 3.4 × 10-3 min-1 and 2.3 ± 4.5 × 10-2 min-1 respectively. The branching ratio for acetaldehyde production from ethanol was 0.46 ± 0.26 and estimated acetaldehyde biological production rates ranged from 0.022 to 0.800 nM min-1. With high bacterial counts, biological production rates from ethanol exceeded photochemical production rates from chromophoric dissolved organic matter. Overall, acetaldehyde production rates were larger than biodegradation rates, suggesting these waters are a source of acetaldehyde to the atmosphere. Extrapolation to higher ethanol concentrations associated with spills suggests that the production rate of acetaldehyde will initially increase and then decrease as ethanol concentrations increase.

Optical properties of chromophoric dissolved organic matter (CDOM) and dissolved organic carbon (DOC) levels in constructed water treatment wetland systems in southern California, USA.

Many removal mechanisms in treatment wetlands involve absorption to organic matter. Optical properties and DOC levels of waters entering and exiting 4 treatment wetland systems in Orange County, Southern California, were measured to characterize the dissolved organic matter pool. Average DOC levels decreased between the inlets and outlets, except for Forge Street (FS), which increased. For 3 wetlands, absorption coefficients decreased between inlet and outlet; the exception was FS, which increased. Average spectral slopes for the inlets and outlets were similar. Average intensities of terrestrial humic peaks A and C from 3D EEM fluorescence spectra decreased between the inlets and outlets for most wetlands. No EEM protein peaks were observed. Average flu/abs ratios for inlets and outlets were similar (high point for FS inlet excluded), suggesting chromophoric dissolved organic matter (CDOM) of a similar composition was present. The average FI value for the inlets and outlets was ∼1.5, consistent with terrestrial sources of CDOM. Average BIX values for the inlets and outlets were ∼0.8, suggesting limited contributions from autochthonous production of CDOM. Dominant plant species in the wetlands were cattail and bulrush. Humic peaks A and C, along with protein peaks, were observed in plant leachates. Protein peaks rapidly degraded with solar simulator irradiation. Results indicate that most of the wetlands are a net sink for CDOM, possibly due to absorption to sediments. The FS wetland appears to have a source of non-CDOM optically active organic carbon, possibly from a pollutant.

The importance of neutral over niche processes in structuring Ediacaran early animal communities.

The relative influence of niche vs. neutral processes in ecosystem dynamics is an on-going debate, but the extent to which they structured the earliest animal communities is unknown. Some of the oldest known metazoan-dominated paleocommunities occur in Ediacaran age (~ 565 million years old) strata in Newfoundland, Canada and Charnwood Forest, UK. These comprise large and diverse populations of sessile organisms that are amenable to spatial point process analyses, enabling inference of the most likely underlying niche or neutral processes governing community structure. We mapped seven Ediacaran paleocommunities using LiDAR, photogrammetry and a laser line probe. We found that neutral processes dominate these paleocommunities, with niche processes exerting limited influence, in contrast with the niche-dominated dynamics of modern marine ecosystems. The dominance of neutral processes suggests that early metazoan diversification may not have been driven by systematic adaptations to the local environment, but instead may have resulted from stochastic demographic differences.

Formation of aligned periodic patterns during the crystallization of organic semiconductor thin films.

Self-organizing patterns with micrometre-scale features are promising for the large-area fabrication of photonic devices and scattering layers in optoelectronics. Pattern formation would ideally occur in the active semiconductor to avoid the need for further processing steps. Here, we report an approach to form periodic patterns in single layers of organic semiconductors by a simple annealing process. When heated, a crystallization front propagates across the film, producing a sinusoidal surface structure with wavelengths comparable to that of near-infrared light. These surface features initially form in the amorphous region within a micrometre of the crystal growth front, probably due to competition between crystal growth and surface mass transport. The pattern wavelength can be tuned from 800 nm to 2,400 nm by varying the film thickness and annealing temperature, and millimetre-scale domain sizes are obtained. This phenomenon could be exploited for the self-assembly of microstructured organic optoelectronic devices.

Using a National Representative Sample to Evaluate the Integrity of the 30-Day Surgical Mortality Metric.

The 30-day surgical mortality metric is endorsed by the National Quality Forum for value-based purchasing purposes. However, its integrity has been questioned, as there is documented evidence of hospital manipulation of this measure, by way of inappropriate palliative care designation and changes in patient selection. To determine if there is evidence of potential manipulation, we retrospectively analyzed 1,725,291 surgical admissions from 158 United States hospitals participating in the National Inpatient Sample from 2010 to 2011. As a way of evaluating unnecessary life-prolonging measures, we determined that a significant increase in mortality rate after post-operative day 30 (day 31-35) would indicate manipulation. We compared the post-operative mortality rates for each hospital between Post-Operative Day 26-30 and Post-Operative Day 31-35 using Wilcoxon signed-rank tests. After application of the Bonferroni correction, the results showed that none of the hospitals had a statistically significant increase in mortality after post-operative day 30. This analysis fails to impugn the integrity of this measure, as we did not identify any evidence of potential manipulation of the 30-day surgical mortality metric.

Photochemical degradation of oil products in seawater monitored by 3D excitation emission matrix (EEM) fluorescence spectroscopy: implications for coloured dissolved organic matter (CDOM) studies.

Fluorescence 3D excitation emission matrix (EEM) spectra of oil products in artificial seawater were monitored as a function of irradiation time in a solar simulator. EEMs were obtained for an excitation range of 240-400 nm and an emission range of 248-830 nm; this is the wavelength range typically used in chromophoric dissolved organic matter (CDOM) EEM studies in natural waters. This allows for comparison to prior work on CDOM in an oil-contaminated salt marsh that attributed a fluorescent component in the tryptophan/tyrosine protein-region to oil. For comparison, EEMs were also measured for a broader excitation range of 220-400 nm typically used in oil related studies to capture the primary oil peak at lower excitation wavelengths. Fluorescence intensities in both excitation wavelength ranges decayed exponentially with irradiation time consistent with first-order kinetics. There was little change in wavelength for primary oil peaks. However, in the CDOM, wavelength range peaks typically shifted to longer excitation and shorter emission wavelengths, moving into the protein peak region of the CDOM EEM spectrum. This is consistent with a decrease in the complexity of the structure of the organic material. Half-lives for photodegradation ranged from 0.36 to 7.2 days for the oil wavelength range and 0.14 to 28 days for the CDOM wavelength range. Higher density oils typically had higher degradation rate constants. Peak locations and peak behaviour are consistent with the primary fluorophore in the oil products being PAH-related.