Ultra-fast prompt gamma detection in single proton counting regime for range monitoring in particle therapy.

In order to fully exploit the ballistic potential of particle therapy, we propose an online range monitoring concept based on time-of-flight (TOF)-resolved prompt gamma (PG) detection in a single proton counting regime. In a proof of principle experiment, different types of monolithic scintillating gamma detectors are read in time coincidence with a diamond-based beam hodoscope, in order to build TOF spectra of PG generated in a target presenting an air cavity of variable thickness. Since the measurement was carried out at low beam currents (< 1 proton/bunch) it was possible to reach excellent coincidence time resolutions, of the order of 100 ps (σ). Our goal is to detect possible deviations of the proton range with respect to treatment planning within a few intense irradiation spots at the beginning of the session and then carry on the treatment at standard beam currents. The measurements were limited to 10 mm proton range shift. A Monte Carlo simulation study reproducing the experiment has shown that a 3 mm shift can be detected at 2σ by a single detector of ∼1.4 × 10-3 absolute detection efficiency within a single irradiation spot (∼108 protons) and an optimised experimental set-up.

Genetic, immunologic, and environmental heterogeneity of IDDM. Incidence and 12-mo follow-up of an Italian population.

The 1-yr incidence of insulin-dependent diabetes mellitus (IDDM) in a population of the Piedmont and Aosta Valley area of Italy was recorded. Anti-virus antibodies (e.g., Coxsackie B1-6, mumps, cytomegalovirus), islet cell antibodies (ICAs), and HLA-A, -B, -C, and -DR were determined in 74 IDDM patients (38 males, 36 females) and in controls. Total IDDM incidence was 5.0/100,000, and the incidence for those less than 20 yr of age was 11.6/100,000. Anti-virus antibody frequency was not different in IDDM patients and controls. ICAs were present in 58% of IDDM patients at onset and in 30% after 12 mo, and complement-fixing ICAs were found in 39 and 17%, respectively. IDDM was significantly and positively associated with DR3/DR4 and negatively associated with DR2 and DR5. ICA frequency was significantly higher in DR3/DR4 heterozygote patients than in patients without DR3 and DR4. These results suggest that in this IDDM population viral etiology is not evident, ICAs offer only a partial pathogenetic explanation, and genetic and immunologic heterogeneity is evident.

Missions of a medical school: a European perspective.

A medical school should be active in various realms, which can be mentioned in a mission statement. Undergraduate training should be situated in the context of medical training as a whole, which does not stop with graduation. Rapid sociocultural change and scientific progress call for production of a "multipotential" graduate, educated at a high scientific standard to keep up with biomedical progress and motivated for continuing education. The graduate should have sound ethical preparation and strong communication skills. In all countries, university hospitals and teaching hospitals should at least contribute to postgraduate specialty training and continuing education. Scientific research must be a fundamental activity of a medical school. Tasks of a faculty include obtaining research funding, solving problems young clinicians face in doing research, and attending to the scientific integrity of researchers. A medical faculty must evaluate itself. Factors in health improvement include appropriate lifestyles and social behaviors; a medical faculty should educate the population in this regard. The faculty should also participate in advising local health administrators, for example by helping to predict the needs of the population and the development of medical care. International cooperation, including joint activities and exchange of information on approaches to problems, can help improve performance in all the areas noted above.

Numbers of physicians and medical students in Europe and the United States.

The authors compared data from the early 1990s for physicians and medical students in the United States with data for those in 14 members of the European Union and 15 other European countries within the European region as defined by the World Health Organization. With a total population twice that of the United States, the European countries had three times the numbers of physicians and first-year students, and five and one-half times the number of applicants to medical schools. Europe has a higher density of physicians (an average of one physician for every 335 people) than the United States (one physician for every 472 people). Numbers of medical schools per million people are similar (1.8 versus 2.0), but the average first-year class size is larger in Europe (184 versus 136 students). There is approximately on first-year medical student per 10,000 people in Europe, compared with one per 15,000 people in the United States. It is likely that these ratios will remain the same, since both the United States and Europe have approximately one first-year medical student for every 30 practicing physicians, and the student admission policies of the individual countries appear to mirror the physician-population ratios. There is one applicant for every 2,125 people in Europe; the United States has one applicant for every 5,174 people. Further, Europe has 4.6 applicants for every place in the class, while the United States has 2.6. Finally, the authors provide detailed information about physicians and students in the countries surveyed.

["Heart transplantation program" in Piedmont. Results of a 3-year activity]. / "Programma trapianto di cuore" della Regione Piemonte. Risultati dopo tre anni di attività.

Since 1990 the "Heart Transplant Program" has been instituted in the Piemonte Region. Until now the program had regular development according to the number of transplantations and the high quality of clinical results. Sixty heart transplantations has been performed with a 36 month survival close to 80%. Our data demonstrate that after heart transplantation prognosis of end-stage cardiac disease is highly improved either for life expectancy and for quality of life. Our program includes several aspects of scientific research from physiology to clinic, from biochemistry to immunology, from infectivology to pathology, from intensive care to surgery. Several very positive multi disciplinary investigations have been activated.

[Assessment of clinical competence of medical school graduates in Italy with standardized patients. The opinion of the examinees]. / Sperimentazione in Italia del metodo del paziente standardizzato per la valutazione della competenza clinica. L'opinione dei neolaureati.

An international collaborative project for the evaluation of clinical competence at the end of the Medical School curriculum using the ECFMG-CSA (Educational Commission for Foreign Medical Graduates--Clinical Skills Assessment) prototype was started in Italy in April 1996. Faculty representatives from Italian Medical Schools and experts from the ECFMG in Philadelphia participated in the Project. The CSA consists of integrated clinical encounters with 10 standardized patients during which the examinee is asked to obtain a focused history, perform a relevant physical examination and communicate initial diagnoses and management plan to the Standardized Patient (SP). The SP then completes checklists that are scored by Faculty members. The project was concluded in Spring 1998 and a total of 173 new graduates were examined. The data elaborated by the primary site in Chieti University will be available in the Fall 1998 by the ECFMG in Philadelphia. This preliminary communication reports the opinions of the examinees on the ECFMG-CSA, contained in the questionnaires administered after the test. Most of the examinees considered this new methodology as a valid tool for the assessment of clinical competence, especially history-taking and interpersonal skills and stated that the SP simulations were realistic. The 72% of examinees indicated that the Medical School curriculum does not adequately prepare for the CSA examination. Lastly, 68% was in favour of including the SP in the Medical Licensing Examination.