Zobrazení zdroje stránky Mcdonaldmoos1022

OBJECTIVE A computational model has been created to estimate the abdominal thickness of a patient following an X-ray examination; its intended application is assisting with patient dose audit of paediatric X-ray examinations. This work evaluates the accuracy of the computational model in a clinical setting for adult patients undergoing anteroposterior (AP) abdomen X-ray examinations. METHODS The model estimates patient thickness using the radiographic image, the exposure factors with which the image was acquired, a priori knowledge of the characteristics of the X-ray unit and detector and the results of extensive Monte Carlo simulation of patient examinations. For 20 patients undergoing AP abdominal X-ray examinations, the model was used to estimate the patient thickness; these estimates were compared against a direct measurement made at the time of the examination. RESULTS Estimates of patient thickness made using the model were on average within ±5.8% of the measured thickness. CONCLUSION The model can be used to accurately estimate the thickness of a patient undergoing an AP abdominal X-ray examination where the patient's size falls within the range of the size of patients used to create the computational model. ADVANCES IN KNOWLEDGE This work demonstrates that it is possible to accurately estimate the AP abdominal thickness of an adult patient using the digital X-ray image and a computational model.Objective There are multiple health benefits associated with both breastfeeding and practicing physical activity (PA). Therefore, it is likely that many women might want to engage in both. We designed the current randomized clinical trial to examine the effect of moderate- to high-intensity PA on human milk (HM) volume and macronutrient contents. Methods and Study Design In this prospective, randomized, crossover clinical trial, we recruited 31 healthy mothers who had been exclusively breastfeeding their infants. Mothers expressed HM twice each day on 2 consecutive days-a day with PA (1-hour before and 1-hour after PA) and a control day without PA (at the exact same hours of the day). The order of days (with/without PA) was determined randomly. Macronutrients and energy contents of HM were analyzed using the Human Milk Analyzer (Miris AB, Uppsala, Sweden). PA was graded according to the Borg Rating of Perceived Exertion scale (RPE scale). Results A total 124 HM samples from 31 mothers were analyzed. Moderate- to high-intensity PA affected neither macronutrients (fat, carbohydrates, protein) nor energy content. Milk volume remained unaffected by PA as well. Conclusions Maternal PA does not affect HM volume or its macronutrient contents. Lactating mothers can be reassured regarding their breast milk volume and composition while practicing PA of moderate to high intensity.Biology experiments in space seek to increase our understanding of what happens to life beyond Earth and how we can safely send life beyond Earth. Spaceflight is associated with many (mal)adaptations in physiology, including decline in musculoskeletal, cardiovascular, vestibular, and immune systems. Biological experiments in space are inherently challenging to implement. Development of hardware and validation of experimental conditions are critical to ensure the collection of high-quality data. The model organism Caenorhabditis elegans has been studied in space for more than 20 years to better understand spaceflight-induced (patho)physiology, particularly spaceflight-induced muscle decline. These experiments have used a variety of hardware configurations. Despite this, hardware used in the past was not available for our most recent experiment, the Molecular Muscle Experiment (MME). Therefore, we had to design and validate flight hardware for MME. MME provides a contemporary example of many of the challenges faced by researchers conducting C. elegans experiments onboard the International Space Station. Here, we describe the hardware selection and validation, in addition to the ground-based experiment scientific validation testing. These experiences and operational solutions allow others to replicate and/or improve our experimental design on future missions.RATIONALE Expansion of chronic ventilation options and shared-decision making have contributed to an increasing population of technology-dependent children. One particularly vulnerable group is children with tracheostomy who depend on technology for basic respiratory functions. Chronic critical care is now provided in the homecare setting with implications for family caregivers. OBJECTIVE This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. We sought to identify the specific unmet needs for families to direct future interventions. METHODS We recruited a convenience sample of families from an established home ventilation program to participate in semi-structured interviews. Sessions were conducted in person or via teleconference. A grounded-theory qualitative analysis was performed. RESULTS Between March 2017 and October 2018, we interviewed 13 individuals representing 12 families of children and/or young adults with tracheostomy. Patients ranged in age from 9 months-28 years, had a tracheostomy for 8 months-18 years and represented a variety of underlying diagnoses. Five key themes emerged 1) navigating home nursing, 2) care coordination and durable medical equipment (DME) impediments, 3) learning as a process, 4) managing emergencies, and 5) setting expectations. CONCLUSION Our findings support the need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.RATIONALE COPD exacerbations are prone to non-recovery but there are no data about the effectiveness of retreatment on these prolonged events. [https://www.selleckchem.com/products/NXY-059.html this website] We examined whether further therapy with ciprofloxacin for incompletely resolved COPD exacerbations prolonged the time until the next event. METHODS This multi-centre randomised double-blind placebo-controlled trial studied retreatment with oral ciprofloxacin 500mg or matched placebo twice daily for 7 days in patients with GOLD stage II - IV COPD with persistent symptoms and/or serum C-reactive protein (CRP) ≥8mg/L initiated 14 (+/- 3) days after an index COPD exacerbation. The primary outcome was the time to the next exacerbation within a 90-day period. RESULTS Of 826 patients screened at 4 centres, 144 eligible participants with incomplete recovery were randomised to receive ciprofloxacin (n=72) or placebo (n=72). 57% of patients in the ciprofloxacin group had experienced 1 or more exacerbations, compared to 53% in the placebo group. The median time to the next exacerbation was 32.5 days (IQR 13-50) in the placebo arm and 34 days (IQR 17-62) in the ciprofloxacin arm, which was not significantly different (adjusted hazard ratio = 1.07, 95% CI 0.68-1.68; p=0.76). No significant differences were seen in quality of life scores or lung function between treatment groups. CONCLUSION In patients with persistent symptoms and/or raised CRP 14 days following a COPD exacerbation, an additional course of ciprofloxacin resulted in no additional benefit compared to placebo. This suggests that non-recovered exacerbations are not driven by ongoing bacterial infection and may potentially be targeted with anti-inflammatory therapy.Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.Lung ischemia-reperfusion (I/R) injury severely endangers human health, and recent studies have suggested that certain microRNAs (miRNAs) play important roles in this pathological phenomenon. The current study aimed to ascertain the ability of miR-223 to influence lung I/R injury by targeting hypoxia-inducible factor-2α (HIF2α). First, mouse models of lung I/R injury were established during surgical procedures, pulmonary arteries and veins and unilateral pulmonary portal vessels were blocked and resuming bilateral pulmonary ventilation, followed by restoration of bipulmonary ventilation. In addition, a lung I/R injury cell model was constructed by exposure to hypoxic reoxygenation (H/R) in mouse pulmonary microvascular endothelial cells (PMVECs). Expression of miR-223, HIF2α and β-catenin in tissues or cells was determined by RT-qPCR and Western blot analysis. Correlation between miR-223 and HIF2α was analyzed by dual luciferase reporter gene assay. Further, lung tissue injury and mouse PMVEC apoptosis was evaluated by HE, TUNEL staining and flow cytometry. Autophagosomes in cells were detected by light chain3 immunofluorescence assay. miR-223 was expressed at a high level while HIF2α/β-catenin was downregulated in tissues and cells with lung I/R injury. Further, miR-223 targeted and repressed HIF2α expression to downregulate β-catenin expression. The miR-223/HIF2α/β-catenin axis aggravated H/R injury in mouse PMVECs and lung I/R injury in mice by enhancing autophagy. Taken together, miR-223 inhibits HIF2α to repress β-catenin, thus contributing to autophagy to complicate lung I/R injury. These findings provide a promising therapeutic target for treating lung I/R injury.OBJECTIVES The objective of this work was to undertake a non-judgemental study of prostate planning practice across the UK by inviting all departments to undertake the same case. METHODS An invitation to take part in the study was sent to the Heads of all UK radiotherapy departments and posted on the UK Medical Physics mailbase. Individuals interested in participating were able to access a single anonymised CT dataset for download with the prostate gland, seminal vesicles, bladder, rectum, bowel, femoral heads and penile bulb outlined. A brief patient history was also supplied. Participants were asked to create PTV volumes according to their local clinical protocol and plan to give 60 Gy in 20 fractions to the PTV receiving the highest dose. No guidance was given for acceptable organ at risk doses. Dicom plan and dose information was loaded back into ProKnow for analysis by contributors. RESULTS There were 102 plan submissions made to the study representing 48 different UK radiotherapy departments. Seventeen distinct methodologies for creating the prescription PTV from the prostate and seminal vesicles were identified with the ethos of the CHHIP trial protocol for margin growing followed in nearly two thirds of cases. Positive correlations were found when assessing the doses received by the bladder and rectum against the volume of the PTV to which 60 Gy was prescribed. CONCLUSIONS A national planning study whereby staff from a multitude of radiotherapy departments create plans based solely on a single dataset is feasible. The cohort of data was made available to all participants following the study to enable self-assessment and benchmarking against that of their peers. ADVANCES IN KNOWLEDGE This is the first UK wide treatment planning study to investigate local clinical prostate planning practice. This has given UK departments the opportunity to evaluate their planning practices against those of their peers.