Validation of quantitative magnetic resonance imaging techniques in head and neck healthy structures involved in the salivary and swallowing function: Accuracy and repeatability.

Background and Purpose: Radiation-induced damage to the organs at risk (OARs) in head-and-neck cancer (HNC) patient can result in long-term complications. Quantitative magnetic resonance imaging (qMRI) techniques such as diffusion-weighted imaging (DWI), DIXON for fat fraction (FF) estimation and T2 mapping could potentially provide a spatial assessment of such damage. The goal of this study is to validate these qMRI techniques in terms of accuracy in phantoms and repeatability in-vivo across a broad selection of healthy OARs in the HN region. Materials and Methods: Scanning was performed at a 3 T diagnostic MRI scanner, including the calculation of apparent diffusion coefficient (ADC) from DWI, FF and T2 maps. Phantoms were scanned to estimate the qMRI techniques bias using Bland-Altman statistics. Twenty-six healthy subjects were scanned twice in a test-retest study to determine repeatability. Repeatability coefficients (RC) were calculated for the parotid, submandibular, sublingual and tubarial salivary glands, oral cavity, pharyngeal constrictor muscle and brainstem. Additionally, a linear mixed-effect model analysis was used to evaluate the effect of subject-specific characteristics on the qMRI values. Results: Bias was 0.009x10-3 mm2/s for ADC, -0.7 % for FF and -7.9 ms for T2. RCs ranged 0.11-0.25x10-3 mm2/s for ADC, 1.2-6.3 % for FF and 2.5-6.3 ms for T2. A significant positive linear relationship between age and the FF and T2 for some of the OARs was found. Conclusion: These qMRI techniques are feasible, accurate and repeatable, which is promising for treatment response monitoring and/or differentiating between healthy and unhealthy tissues due to radiation-induced damage in HNC patients.

Increasing market opportunities for renewable energy technologies with innovations in aquifer thermal energy storage.

Heating and cooling using aquifer thermal energy storage (ATES) has hardly been applied outside the Netherlands, even though it could make a valuable contribution to the energy transition. The Climate-KIC project "Europe-wide Use of Energy from aquifers" - E-USE(aq) - aimed to pave the way for Europe-wide application of ATES, through the realization and monitoring of six ATES pilot plants across five different EU countries. In a preceding paper, based on preliminary results of E-USE(aq), conclusions were already drawn, demonstrating how the barriers for this form of shallow geothermal energy can be overcome, and sometimes even leveraged as opportunities. Based on final pilot project results, key economic and environmental outcomes are now presented. This paper starts with the analysis of specific technological barriers: unfamiliarity with the subsurface, presumed limited compatibility with existing energy provision systems (especially district heating), energy imbalances and groundwater contamination. The paper then shows how these barriers have been tackled, using improved site investigation and monitoring technologies to map heterogeneous subsoils. In this way ATES can cost-efficiently be included in smart grids and combined with other sources of renewable (especially solar) energy, while at the same time achieving groundwater remediation. A comparative assessment of economic and environmental impacts of the pilots is included, to demonstrate the sustainability of ATES system with different renewables and renewable-based technologies. The paper concludes with an assessment of the market application potential of ATES, including in areas with water scarcity, and a review of climate beneficial impact.

Scenarios to limit environmental nitrogen losses from dairy expansion.

Increased global demand for dairy produce and the abolition of EU milk quotas have resulted in expansion in dairy production across Europe and particularly in Ireland. Simultaneously, there is increasing pressure to reduce the impact of nitrogen (N) losses to air and groundwater on the environment. In order to develop grassland management strategies for grazing systems that meet environmental targets and are economically sustainable, it is imperative that individual mitigation measures for N efficiency are assessed at farm system level. To this end, we developed an excel-based N flow model simulating an Irish grass-based dairy farm, to evaluate the effect of farm management on N efficiency, N losses, production and economic performance. The model was applied to assess the effect of different strategies to achieve the increased production goals on N utilization, N loss pathways and economic performance at farm level. The three strategies investigated included increased milk production through increased grass production, through increased concentrate feeding and by applying a high profit grass-based system. Additionally, three mitigation measures; low ammonia emission slurry application, the use of urease and nitrification inhibitors and the combination of both were applied to the three strategies. Absolute N emissions were higher for all intensification scenarios (up to 124 kg N ha-1) compared to the baseline (80 kg N ha-1) due to increased animal numbers and higher feed and/or fertiliser inputs. However, some intensification strategies showed the potential to reduce the emissions per ton milk produced for some of the N-loss pathways. The model showed that the assessed mitigation measures can play an important role in ameliorating the increased emissions associated with intensification, but may not be adequate to entirely offset absolute increases. Further improvements in farm N use efficiency and alternatives to mineral fertilisers will be required to decouple production from reactive N emissions.

Low carbon heating and cooling by combining various technologies with Aquifer Thermal Energy Storage.

A transition to a low carbon energy system is needed to respond to global challenge of climate change mitigation. Aquifer Thermal Energy Storage (ATES) is a technology with worldwide potential to provide sustainable space heating and cooling by (seasonal) storage and recovery of heat in the subsurface. However, adoption of ATES varies strongly across Europe, because of both technical as well as organizational barriers, e.g. differences in climatic and subsurface conditions and legislation respectively. After identification of all these barriers in a Climate-KIC research project, six ATES pilot systems have been installed in five different EU-countries aiming to show how such barriers can be overcome. This paper presents the results of the barrier analysis and of the pilot plants. The barriers are categorized in general barriers, and barriers for mature and immature markets. Two pilots show how ATES can be successfully used to re-develop contaminated sites by combining ATES with soil remediation. Two other pilots show the added value of ATES because its storage capacity enables the utilization of solar heat in combination with solar power production. Finally, two pilots are realized in countries with legal barriers where ATES systems have not previously been applied at all.

Progression of hearing loss after LINAC-based stereotactic radiotherapy for vestibular schwannoma is associated with cochlear dose, not with pre-treatment hearing level.

BACKGROUND: Although stereotactic radiotherapy (SRT) for vestibular schwannoma has demonstrated excellent local control rates, hearing deterioration is often reported after treatment. We therefore wished to assess the change in hearing loss after SRT and to determine which patient, tumor and treatment-related factors influence deterioration. METHODS: We retrospectively analyzed progression of hearing loss in patients with vestibular schwannoma who had received stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) as a primary treatment between 2000 and 2014. SRS had been delivered as a single fraction of 12 Gy, and patients treated with FSRT had received 30 fractions of 1.8 Gy. To compare the effects of SRS and FSRT, we converted cochlear doses into EQD2. Primary outcomes were loss of functional hearing, Gardner Robertson (GR) classes I and II, and loss of baseline hearing class. These events were used in Kaplan Meier plots and Cox regression. We also calculated the rate of change in Pure Tone Average (PTA) in dB per month elapsed after radiation-a measure we use in linear regression-to assess the associations between the rate of change in PTA and age, pre-treatment hearing level, tumor size, dose scheme, cochlear dose, and time elapsed after treatment (time-to-first-audiogram). RESULTS: The median follow-up was 36 months for 67 SRS patients and 63 months for 27 FSRT patients. Multivariate Cox regression and in linear regression both showed that the cochlear V90 was significantly associated with the progression of hearing loss. But although pre-treatment PTA correlated with rate of change in Cox regression, it did not correlate in linear regression. The time-to-first-audiogram was also significantly associated, indicating time dependency of the rate of change. None of the analysis showed a significant difference between dose schemes. CONCLUSIONS: We found no significant difference between SRS and FSRT. As the deterioration in hearing after radiotherapy for vestibular schwannoma was associated with the cochlea V90, restricting the V90 may reduce progression of hearing loss. The association between loss of functional hearing and baseline PTA seems to be biased by the use of a categorized variable for hearing loss.

Antiepileptic drug utilization in children from 1997-2005--a study from the Netherlands.

OBJECTIVE: To investigate the utilization of antiepileptic drugs (AEDs) in Dutch children and compare this with guidelines on the treatment of epilepsy in children. METHOD: From the Dutch Interaction Database (IADB.nl) we selected children aged 0-19 years who received at least one prescription for an AED (ATC-code beginning with N03A) between 1997 and 2005. We calculated cumulative incidences and prevalences per 1000 children per year, stratified by age-category, sex and type of AED, and the total number of months each patient received at least one prescription of AEDs, and we counted the number of person-months and AEDs prescribed. For each AED, proportions of person-months were calculated for mono- and combination therapy. Kaplan-Meier survival analysis was used to analyse the duration of AED use, stratified by sex. RESULTS: The overall prevalence of the prescription of AEDs to children was constant at approximately 4.0 per 1000 children during the years of the study. The overall cumulative incidence from 1997-2005 was 0.67 per 1000 children. When stratified by age category or sex, there were no relevant differences in incidence or prevalence. Valproic acid was the most frequently prescribed drug, followed by carbamazepine and lamotrigine. In 20.3% of all person-months, patients received combination therapy; of these, 34.2% received combination therapy for 3 person-months or less. The older AEDs were prescribed more often as monotherapy than combination therapy, in contrast with the newer AEDs, for which the opposite was true. The 50% survival probability (= time period when 50% of children had stopped using AEDs) was around 2 years, with a significantly lower discontinuation of treatment for girls than boys (P = 0.04). CONCLUSION: The overall cumulative incidence of AEDs was determined to be 0.67 per 1000 children, and the prevalence 4.0 per 1000 children. The most frequently prescribed drug is valproic acid, followed by carbamazepine and lamotrigine. The prescribing of AEDs seems to be in conformity with the overall recommendations of the guidelines on the treatment of epilepsy in children.