Don't Listen With Your Mouth Full: The Role of Facial Motor Action in Visual Speech Perception.

Theories of speech perception agree that visual input enhances the understanding of speech but disagree on whether physically mimicking the speaker improves understanding. This study investigated whether facial motor mimicry facilitates visual speech perception by testing whether blocking facial motor action impairs speechreading performance. Thirty-five typically developing children (19 boys; 16 girls; M age = 7 years) completed the Revised Craig Lipreading Inventory under two conditions. While observing silent videos of 15 words being spoken, participants either held a tongue depressor horizontally with their teeth (blocking facial motor action) or squeezed a ball with one hand (allowing facial motor action). As hypothesized, blocking motor action resulted in fewer correctly understood words than that of the control task. The results suggest that facial mimicry or other methods of facial action support visual speech perception in children. Future studies on the impact of motor action on the typical and atypical development of speech perception are warranted.

Supportive Transition Planning for Adolescents Transitioning From Psychiatric Hospitalization to School: A Systematic Literature Review and Framework of Practices.

School-aged youth with behavioral health needs often struggle in the academic environment. When admitted to acute psychiatric hospital settings, the student's difficulties and needs increase upon discharge and return to the school setting. While the literature describes systemic issues in transitioning from an acute psychiatric hospital to the school setting, limited resources exist for practitioners to plan for and support the successful reintegration of affected students. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the purpose of the current systematic review was to collect and synthesize evidence from the literature (N = 20) in the areas of barriers, challenges, and significance of the need for a formal transition planning framework. Four major key factors emerged as important to assist in creating a transition planning framework for acute psychiatric hospitals to school-based settings: (a) Stakeholder Voice (Student, Caregiver, Hospital/Treatment Team, or School Team Voice); (b) Establishing a Point Person for Transition (Medical or School Point Person); (c) Recommendations/Accommodations (Formal or Informal Supports); and (d) Having a Transition Meeting. Other common factors are discussed, and recommendations are provided to aid practitioners in increasing the likelihood that school-age youth succeed in the school environment post-discharge from acute psychiatric settings. Finally, gaps in the literature are identified as areas for further research.

Codeveloping and Evaluating a Campaign to Reduce Dementia Misconceptions on Twitter: Machine Learning Study.

Background: Dementia misconceptions on Twitter can have detrimental or harmful effects. Machine learning (ML) models codeveloped with carers provide a method to identify these and help in evaluating awareness campaigns. Objective: This study aimed to develop an ML model to distinguish between misconceptions and neutral tweets and to develop, deploy, and evaluate an awareness campaign to tackle dementia misconceptions. Methods: Taking 1414 tweets rated by carers from our previous work, we built 4 ML models. Using a 5-fold cross-validation, we evaluated them and performed a further blind validation with carers for the best 2 ML models; from this blind validation, we selected the best model overall. We codeveloped an awareness campaign and collected pre-post campaign tweets (N=4880), classifying them with our model as misconceptions or not. We analyzed dementia tweets from the United Kingdom across the campaign period (N=7124) to investigate how current events influenced misconception prevalence during this time. Results: A random forest model best identified misconceptions with an accuracy of 82% from blind validation and found that 37% of the UK tweets (N=7124) about dementia across the campaign period were misconceptions. From this, we could track how the prevalence of misconceptions changed in response to top news stories in the United Kingdom. Misconceptions significantly rose around political topics and were highest (22/28, 79% of the dementia tweets) when there was controversy over the UK government allowing to continue hunting during the COVID-19 pandemic. After our campaign, there was no significant change in the prevalence of misconceptions. Conclusions: Through codevelopment with carers, we developed an accurate ML model to predict misconceptions in dementia tweets. Our awareness campaign was ineffective, but similar campaigns could be enhanced through ML to respond to current events that affect misconceptions in real time.

Investigation of Carers' Perspectives of Dementia Misconceptions on Twitter: Focus Group Study.

BACKGROUND: Dementia misconceptions on social media are common, with negative effects on people with the condition, their carers, and those who know them. This study codeveloped a thematic framework with carers to understand the forms these misconceptions take on Twitter. OBJECTIVE: The aim of this study is to identify and analyze types of dementia conversations on Twitter using participatory methods. METHODS: A total of 3 focus groups with dementia carers were held to develop a framework of dementia misconceptions based on their experiences. Dementia-related tweets were collected from Twitter's official application programming interface using neutral and negative search terms defined by the literature and by carers (N=48,211). A sample of these tweets was selected with equal numbers of neutral and negative words (n=1497), which was validated in individual ratings by carers. We then used the framework to analyze, in detail, a sample of carer-rated negative tweets (n=863). RESULTS: A total of 25.94% (12,507/48,211) of our tweet corpus contained negative search terms about dementia. The carers' framework had 3 negative and 3 neutral categories. Our thematic analysis of carer-rated negative tweets found 9 themes, including the use of weaponizing language to insult politicians (469/863, 54.3%), using dehumanizing or outdated words or statements about members of the public (n=143, 16.6%), unfounded claims about the cures or causes of dementia (n=11, 1.3%), or providing armchair diagnoses of dementia (n=21, 2.4%). CONCLUSIONS: This is the first study to use participatory methods to develop a framework that identifies dementia misconceptions on Twitter. We show that misconceptions and stigmatizing language are not rare. They manifest through minimizing and underestimating language. Web-based campaigns aiming to reduce discrimination and stigma about dementia could target those who use negative vocabulary and reduce the misconceptions that are being propagated, thus improving general awareness.

The implementation of a novel patient symptom screening tool: The Odette Cancer Centre (OCC) experience.

AIM: In 2017, as part of a readiness plan for the launch of a novel symptom screening tool for prostate cancer patients, an interprofessional working group was assembled at Odette Cancer Centre (OCC). A provincial Phase II pilot for the tool had stated (based on stakeholder feedback) that there was a need to: "Develop training and resources for patients and clinicians that facilitate the interpretation of patient reported outcomes measures (PROMs) …." With this recommendation in mind, the working group aimed to develop and implement a training and education plan. The plan would support healthcare professionals (HCPs) in their clinical response to the PROM tool symptom screening scores.The aim was to encourage evidence based symptom management and therefore improve care for patients. PROCESS: A questionnaire was developed to elicit information regarding HCP's comfort level and knowledge related to issues experienced by prostate cancer patients. The issues were categorised according to the domains identified within the screening tool, i.e., bowel, urinary, sexual and hormonal/vitality domains. The questionnaire was emailed to all identified stakeholders via institutional email. Feedback from the questionnaire was utilised to develop an education work plan. Five education sessions were developed with pre session materials shared via email. Each session was evaluated via an anonymous and voluntary three item questionnaire completed at the end of each session. Chart audits of 20 prostate cancer patients' electronic medical records (EMR) were carried out pre and post launch of the education program and the novel screening tool. The audit process was to support assessment of any changes in HCPs clinical response to prostate cancer patient issues. RESULTS: There were 50 responses to the preliminary needs assessment questionnaire (approximately 29% response rate). The sexual health domain was identified as the one with which HCPs had the least knowledge and comfort level. Five education sessions were developed and carried out with an average attendance of 14 HCPs from a variety of disciplines. Feedback demonstrated that the majority of attendees agreed or strongly agreed that the sessions increased their knowledge on each of the topics and that they were deemed useful for their clinical practice.The audit data showed differences in documentation of patient issues pre and post education program and implementation of the novel screening tool. CONCLUSIONS: Employing a systematic approach, with interprofessional engagement, can support successful adoption of new initiatives such as a novel site specific screening tool. Ongoing assessment of HCPs education needs can be carried out using this process. Establishing a database of resources to facilitate independent education may be useful for some HCPs.

Sexual Health Issues in Patients with Cancer-An Exploratory Mixed Methods Study of the Awareness Levels of Radiation Therapists.

INTRODUCTION: Patients with cancer report dissatisfaction with care they receive in relation to changes affecting intimacy and relationships. Health care professionals describe barriers in providing support in these areas due to lack of time, training, education, and privacy. Radiation therapists (RTs) play a key role in cancer care, but there is little evidence in the literature of their role in sexual health care. This project investigated awareness levels of RTs in sexual health issues related to patients with cancer receiving radiation therapy. METHODS: A prospective mixed methods approach was used for this investigation. Quantitative data was collected via an online questionnaire developed from the literature. Two hundred eighty-four RTs from two large cancer centers were eligible to participate; 84 responded (29%). Two focus groups were conducted with 15 volunteer RTs to validate questionnaire data and further explore the topic. Content analysis was used to identify key themes from the qualitative data. RESULTS: RT respondents acknowledged the complexity of sexual health issues in patients with cancer. Eighty-five percent (n = 56) strongly agreed/agreed that all patients with cancer, regardless of cancer site, can experience issues which may affect sexual health. Ninety-two percent (n = 61) strongly agreed/agreed that sexual health is important for a persons' quality of life. As part of the radiation therapy treatment planning process, 54.5% of RTs (n = 31) strongly agreed/agreed that they consider the impact of physical side effects of radiation therapy on the sexual health of patients; during treatment delivery, 56% (n = 36) agreed/strongly agreed that they consider the physical side effects on their patients' sexual health. CONCLUSIONS: Data indicated that RTs are aware that a cancer diagnosis and the subsequent treatments may lead to issues that affect sexual health. They are aware of the complex nature of sexual health and understand its importance in a persons' quality of life and that all patients with cancer regardless of site may experience issues which can impact their sexual health. Their responses suggest that they can relate their training and clinical practice to sexual health issues experienced by patients in their care. Current RT involvement in sexual health care is limited due to various process and environmental factors similar to those found in other health care professionals practice. By eliminating these barriers and supporting the inclusion of sexual health into the clinical practice of RTs, health care resources can be maximized to support the resolution of unmet needs of patients and their partners. In that way the quality of patient care services can be improved.

A Pilot Project to Investigate Radiation Therapist Referrals to an Ad Hoc Supportive Care Oncology Clinic.

PURPOSE/AIM: Approximately 400 patients are treated daily within the radiation therapy (XRT) department at the cancer centre where this project took place. As part of their clinical interactions during the treatment delivery process, radiation therapists (MRTs) may refer patients to a third party "RN Assessment Office" for non technical issues. These referrals can result in extended wait times for patients as well as disruptions to the scheduling of MRTs and other health care professionals. This review aimed to identify issues that resulted in third party referrals by MRTs. Data collected may enable insight into the issues that prompt third party referrals and help support MRTs in managing patient issues that are within their scope of practice. METHOD/PROCESS: A database of XRT patient referrals to the location "RN Assessment Office" in the electronic records (EMRs) was generated for this review. A 4-week period within the previous year was considered suitable by the investigators to produce a representative sample of referrals. Predetermined referral categories were compiled based on the experiences of the investigators. Data were extracted from two sources: (1) the progress note tab within each patient EMR and (2) the comments section of the registered nurses (RNs) Assessment workload location in the EMR systems. RESULTS/BENEFITS/CHALLENGES: Data demonstrated that 17% of the progress notes in the EMR contained MRT documentation before referral. The majority of referrals (29%) were related to patient skin reactions and wound/dressing care. CONCLUSIONS/IMPACT/OUTCOMES: Absence of documentation by MRTs in the EMR impaired the data collection. Anecdotal evidence suggests routine MRT patient assessment during the XRT process. Recommendations related to systematic assessments and documentation procedures may increase MRT documentation. Streamlining the referral processes may improve efficiencies and eliminate redundancies in the workflow of MRTs.

It Only Takes a Minute: The Development and Implementation of a Patient Experience Survey in Radiation Therapy.

INTRODUCTION: Health care services use surveys to assess patient satisfaction and identify areas for improvement. While it is important to assess patient satisfaction to ensure their needs are met, lengthy questionnaires with closed-ended questions often focus on areas that may be considered important by institutions rather than patients. Recently, focus has shifted toward patient and caregiver experience, which institutions address via appreciative inquiry. The aim of this initiative was the development of a patient experience survey (PES) for radiation therapy patients and caregivers which would allow them to express their opinions and priorities. This patient feedback would then be addressed through quality improvement (QI) projects geared toward improving the overall patient and caregiver experience in radiation therapy. METHODS: A three-question minute survey was developed for use as a PES in the radiation therapy department of an academic oncology program located in a large metropolitan area. Feedback was obtained from patient education and person-centred care experts, as well as 10 radiation therapy patients. All feedback was incorporated to create the final PES; respondents rated their agreement on a five-point Likert scale with the statement "My overall experience in Radiation Therapy was great" and two open-ended questions allowed them to highlight departmental strengths and areas for improvement. An initial 3-month pilot was conducted where PESs were available on a self-serve basis to patients and caregivers in waiting areas and at radiation therapy treatment units. All responses were anonymous and completed surveys were returned via drop boxes. Descriptive statistics and thematic analysis were used to analyse responses. RESULTS: A total of 86 surveys were returned. Of those, 80 (93%) responded to the Likert scale question with 83% agreeing or strongly agreeing that their experience in radiation therapy was great. Several strengths were identified by respondents including teamwork, professionalism, and knowledge. Areas identified for improvement included management of appointment delays and communication of delays to patients, as well as environmental improvements. CONCLUSIONS: Although most respondents reported a favourable experience, this pilot demonstrated the minute survey can identify areas for improvement that can be addressed through QI. Including the patient perspective in QI is evidenced to enhance its outcome and aligns with institutional, provincial, and national strategic goals of improving the quality of cancer care through patient engagement.

Three Episodes of Takotsubo Cardiomyopathy with Variant Ballooning Patterns in 2 Elderly Women.

Takotsubo cardiomyopathy can present with transient apical, midventricular, or basal left ventricular ballooning patterns. Reported recurrences of this cardiomyopathy are few. We present the cases of 2 elderly women who each had 3 episodes of takotsubo cardiomyopathy in various ballooning patterns. We explore the potential pathophysiologic mechanisms, and we discuss the best treatment approach for this disease, which carries a substantial risk of in-hospital complications.

Sexual healthcare for cancer patients receiving palliative care: a narrative review.

Palliative care aims to improve quality of life (QoL) for patients and families and does so by addressing issues not limited to pathology, but other symptoms that may be debilitating to patient experience and QoL. Despite sexual health being an important aspect of life for many patients, it is often omitted in clinical practice. This review summarizes published primary studies to explore the prevalence and importance of incorporating sexual health in the symptom screening and assessments of palliative patients, to identify current interventions that are implemented to address sexual health issues, and identify the barriers that health care professionals (HCPs) and patients may encounter which may prevent sexual health discussions. A literature review was conducted on Medline and Embase databases using keywords including "cancer", "sexual health", "intimacy", and "palliative care". Eleven papers focusing on the sexual health and intimacy of terminally ill patients in hospice, palliative or terminal care settings were identified for inclusion. Discussions about sexual health, functioning, and intimacy were not common in patient care, despite being a service that both patients and their partners desired. Referrals to sexologists, or discussions with patients and partners about intimacy and sexuality over the course of the disease trajectory were shown to improve QoL as well as alleviate some of the stress of receiving palliative care services. HCPs cited a lack of training, their own life experiences, or discomfort with the topic as barriers to initiating conversations with patients. In conclusion, sexuality and intimacy remain important parts of many people's lives regardless of their health, and should be incorporated into the care of all patients including those in palliative care. There is a need for further research to evaluate different methods or procedures for educating and counselling patients and their partners on sexual health issues. HCPs should have specific training and education in sexual health care to enable them to initiate and direct these discussions.

'Bottom dog men': Disability, Social Welfare and Advocacy in the Scottish Coalfields in the Interwar Years, 1918-1939.

This article connects with and builds on recent research on workmen's compensation and disability focussing on the Scottish coalfields between the wars. It draws upon a range of primary sources including coal company accident books, court cases and trade union records to analyse efforts to define and redefine disability, examining the language deployed and the agency of workers and their advocates. It is argued here that the workmen's compensation system associated disability with restricted functionality relating to work tasks and work environments. Disability became more visible and more closely monitored and this was a notably contested and adversarial terrain in Scotland in the Depression, where employers, workers and their collective organisations increasingly deployed medical expertise to support their cases regarding working and disabled bodies. In Scotland, the miners' trade unions emerged as key advocates for the disabled.

Clinical presentations of below knee bone metastases: a case series.

Bone metastases are a common complication of advanced malignancy; however, presentation of below-the-knee metastases, particularly affecting the fibula and tibia, are infrequently observed in both the clinical setting and the literature, and present a therapeutic challenge to patients and physicians alike. Due to the weight-bearing capacity of bones below-the-knee, the disruption of the structural and functional integrity of these bones can reduce mobility and thus quality of life. Treatment options for these patients include surgery, radiotherapy, and/or chemotherapy. Candidates for surgery typically have affected weightbearing bones. For patients not suitable for surgery, radiotherapy is prescribed for pain relief and bone remineralization. Herein, we report four cases in which two female and two male patients developed painful below knee metastases. Orthopedic surgery was consulted for all cases. Two patients underwent surgical fixation followed by radiotherapy, while the other two received palliative radiotherapy alone.

Adverse Health Outcomes Associated with Postdiagnosis Smoking in Prostate Cancer Patients: A Literature Review.

This literature review presents what is currently known about the association between postdiagnosis smoking and adverse health outcomes in prostate cancer. A literature search was conducted using Ovid Embase and Ovid MEDLINE. Information from 36 studies was summarized. There is strong evidence across the included studies of higher overall mortality and biochemical recurrence in current smokers diagnosed with prostate cancer. In addition, enhanced adverse effects following surgery, radiation, and hormone therapy have also been identified in current smokers of this population.

Efficacy of postoperative radiation treatment for bone metastases in the extremities.

BACKGROUND AND PURPOSE: Impending or pathological fractures due to bone metastases may require surgical fixation. Postoperative radiation is often recommended to reduce local progression and prevent prosthesis displacement, hence reducing the need for second surgery. The objectives of this study were to investigate the need for second surgery, and to report on rates of re-irradiation, tumor progression and prosthesis displacement following postoperative radiation. MATERIALS AND METHODS: Data were collected from 65 patients who received postoperative radiation to 74 sites in the extremities in a palliative radiation clinic between January 2009 and January 2017. Descriptive statistical analyses were performed. RESULTS: Only 2 patients required a second surgery (2.7%) at 9 and 10months after postoperative radiation. Increase in pain requiring re-irradiation was reported in 7 patients (9.5%), at a median time of 9.3months after the delivery of radiation. Of the 47 patients who had radiological imaging available post-radiation, local progression of bone metastases was seen in 8 patients (17.0%) and displacement of the prosthesis in 1 patient (2.1%). CONCLUSION: Rates of prosthesis displacement and progression of bone metastases at site of surgery were low after postoperative radiation. There were few incidences of second surgery and re-irradiation observed in the cohort. These findings provide support for the benefit of postoperative radiation.

Factors Affecting Treatment Outcome in Elderly Head and Neck Cancer Patients: A Retrospective Pilot Study.

BACKGROUND: Head and neck cancer (HNC), the fifth most common cancer worldwide, is a complicated category of diseases comprised of cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx. Management of HNC can be very complex, with surgery, chemotherapy, and radiation therapy often used in combination to achieve optimal results. The optimal combination of therapies to maximize patient survival and post-treatment quality of life is yet unclear. Only some prognostic factors for HNC are relatively well understood, whereas others are affected by conflicting results of their significance. AIMS: The present study will explore and attempt to clarify the prognostic factors affecting HNC patients, focusing specifically on patients aged 80 or older. METHODS: A database of HNC patients treated at our center between 2006 and 2011 was generated in Mosaiq (an electronic patient record system); from this, a sample of patients aged 80 or older was selected randomly (n = 40). Various disease-, patient-, and treatment-related factors were collected from these records and compared against the patients' overall survival, disease-free status, rates of recurrence, and rates of radiation toxicity to determine which were significant prognostic indicators. CONCLUSIONS: Disease subsite was found to be a significant indicator of local recurrence (P = .049) and survival rate (P = .014), while anemia was related to poor disease-free status on follow-up (P = .017). Age was not significantly linked to any outcome measure. However, patients treated with palliative intent were significantly older (P = .012) despite not having higher stage disease, and only one radical patient (3.2%) failed to complete their treatment course. Follow-up data, quantitative toxicity data, and human papillomavirus and smoking status were either inconsistently collected or unavailable, identifying areas for improvement to better inform evidence-based practice.

An Overview of Radiation-Induced Nausea and Vomiting.

BACKGROUND: Radiation-induced nausea and vomiting (RINV) is common occurrence in cancer patients treated with radiotherapy. When radiation is prescribed to certain sites, it can lead to retching, vomiting, and nausea that can lead to impairments on quality of life and even effect adherence to treatment regimes. The present study reports select literature examining RINV phenomena and reviews mechanisms of RINV as well as current management strategies. METHODS: A literature search was conducted on PubMed using search strategies such as "radiation-induced nausea vomiting," "RINV," and "radiation and antiemetics." The search was limited to articles published from January 2000 to April 2016 and those that involved humans and were published in English. Information regarding emetic risk of each treatment and management strategies used were extracted from each article. RESULTS: A total of 25 articles were included in this select review. The current evidence regarding the standard antiemetics for RIINV are discussed, as well as upcoming therapies and future potential endeavors. CONCLUSIONS: Cancer patients treated with emetogenic radiotherapy are at risk of experiencing RINV. RINV has the potential to impact patient quality of life and treatment delivery and optimal prophylactic strategies should be implemented, particularly in radiation naïve patients. More awareness on these topics is warranted, so that standard antiemetic regimens can be used in both the prophylactic and rescue settings.

Pelvic insufficiency fractures in women following radiation treatment: a case series.

Insufficiency fractures are stress fractures that occur from normal weight-bearing on weakened bone. Radiation treatment to malignancies in the prostate, rectum, anus, or cervix may increase the risk of insufficiency fractures in the pelvic region by damaging osteoblasts that are essential to bone formation. In elderly women with cancer, this risk is greater due to their susceptibility to developing osteoporosis. These fractures may be confused with pathological fractures resulting from bone metastases on imaging and should be identified for proper management. We report two cases in which two women developed painful insufficiency fractures in the pelvic region after receiving radiation treatment to the rectum. After consulting an orthopedic surgeon, one patient underwent a cementoplasty, while the other patient was encouraged to take bone strengthening medications.

An Investigation of the Feasibility and Utility of a Low-dose Cone-beam Computed Tomography Scan Protocol for Head and Neck Cancer Patients.

INTRODUCTION: Routine use of cone-beam computed tomography (CBCT) scan protocols as part of the image guidance process (image-guided radiation therapy) has become an integral part of the practice of radiation therapists (RTs). Concerns regarding imaging dose as well as increased in-room time for patients led to reluctance among site group members to adopt CBCT for all radical head and neck cancer (HNC) patients at our institution. This investigation set out to assess the feasibility and utility of a revised CBCT scan protocol with the aim of supporting daily CBCT for HNC patients receiving radiation therapy. METHODS: The project was performed in three phases. Phase 1 involved the experimental adjustment of CBCT scan protocol parameters in clinical use for HNC patients at our institution. An Elekta Synergy linear accelerator with kilovoltage CBCT capability and a RANDO head phantom were used for scan acquisition procedures. Image registration using bony anatomy was performed on two image sets generated using the current clinical scan protocol (HNS20) and an experimental modified scan protocol (MHNS20). Image registration results were compared by two investigators. Measurements of scan doses using a metal-oxide-semiconductor field-effect transistor and a Unidose meter were performed. Catphan phantom images were acquired using HNS20 and MHNS20 protocols. In phase 2, ten volunteer RTs performed image registration and matching processes on two image sets performed using HNS20 and MHNS20 protocols. RTs were unaware of the scan protocols used for image acquisition. A threshold of 3 mm was set (the current maximum couch shift allowance in the clinical HNC IGRT protocol) to compare the image registration data from HNS20 and MHNS20. In phase 3, after research ethics board approval, 10 HNC patients consented to the study. Two pretreatment CBCT scans were performed: scan 1 was acquired using MHNS20 protocol, and scan 2 was acquired using the HNS20 protocol. A threshold of 2 mm was set to compare the differences in couch shift data resulting from the image registration of the two image sets. Comparison of HNS20 and MHNS20 based on image registration results was performed. RESULTS: In phase 1, radiation doses measured by the investigators on the left optical lens using a metal-oxide-semiconductor field-effect transistor and a Unidose meter indicated that the MHNS20 protocol would result in a lower dose to the left optical lens. In phase 2, shifts of the treatment table to achieve the planned isocentre, which were recorded after the image matching process, were within 3 mm in 80% of the RT procedures. In the y-axis (superior/inferior direction), 100% of the procedures were within 3 mm. In the z-axis (anterior/posterior) and x-axis (lateral), 90% of the procedures were within 3 mm. Qualitative data from a questionnaire completed by RTs after the image matching indicated that 50% of the RTs had no preference between the images sets in terms of visibility of structures. Forty percent of RTs had no preference regarding speed of matching or preference for registration between the image sets. When a preference was indicated, the HNS20 scan protocol was chosen by the RTs. In phase 3, couch shift data recorded after each CBCT scan were compared. All results in all three planes for 10 patients included in the study were within the 2-mm threshold. CONCLUSIONS: The feasibility and clinical utility of a potential lower-dose CBCT scan protocol has been investigated. The modified protocol (MHNS20) produced image data acceptable within current practice using bony anatomy for registration purposes. The MHNS20 protocol also delivered lower doses to the left optical lens and therefore potentially to other pertinent structures. The actual delivered doses to patients during IGRT procedures using the MHNS20 may be different than those measured during this investigation.

Time and energy constraints on the brood size of swallows, Hirundo rustica, and sand martins, Riparia riparia.

The daily energy requirements of swallow Hirundo rustica and sand martin Riparia riparia adults with broods of different sizes were compared with the energy (food) gain rates of adults. Energy requirements of broods were obtained from food delivery rates, growth rates and from published data. The energy requirements of adults were obtained from D2O18 measurements and from time budgets. Energy gain rates were measured from food delivery rates to collared nestlings. These energy gain rates were reduced in bad weather when food abundance was low. In good weather, energy gain rates were theoretically high enough to supply the energy needs of larger than normal broods. In bad weather, however, the adults would only be able to collect sufficient energy for a normal brood of four to six. I suggest that this effect of weather and feeding conditions on energy gain rates and, hence, on reproductive effort is an important factor in limiting the upper level of brood size in these species.