Additional Time Research Articles

Neutral effect of nitrogen addition and negative effect of precipitation reduction on the soil faunal community in a temperate forest

ABSTRACT Nitrogen deposition can promote belowground soil carbon pools, and precipitation reduction can eliminate this positive effect. Soil fauna play crucial roles in regulating the dynamics of organic matter and maintaining biodiversity in ecosystems. However, it is not clear whether belowground soil fauna have similar responses to changes after long-term nitrogen deposition and drought. We simulated nitrogen deposition by applying fertilizer, and simulated drought by excluding 30% of the ambient precipitation in a temperate forest from 2009. Our results showed that experimental precipitation reduction alone significantly changed the composition and decreased the abundance of the soil faunal community. Precipitation reduction could also promote the soil food web in a fungal-dominated pathway by decreasing trophic groups of Isotomidae abundance. In contrast, although nitrogen addition treatment increased soil available nitrogen content, it had a neutral effect on the soil faunal community. Soil faunal community showed strong temporal variations in response to both nitrogen deposition and precipitation reduction treatments. Notably, interactions between precipitation reduction, nitrogen addition, and sampling time were significant for specific trophic groups, including saprozoites and omnivores. Shannon-Weiner diversity was not sensitive to these global change factors. Our results suggest that soil water content and plant richness may, directly and indirectly, regulate the soil faunal community.

The Effects of Light Treatments on Growth and Flowering Characteristics of Oncidesa Gower Ramsey ‘Honey Angel’ at Different Growth Stages

In our previous work, we observed that Oncidesa Gower Ramsey ‘Honey Angel’ (HA) plants became stunned on hot summer afternoons, and the seasonal trend in solar radiation affected its production schedule by limiting flower yield and quality. The objective of this work was to study the growth and flowering characteristics of HA pseudobulbs at three stages of growth (G2–G4) in response to three types of light-emitting diode (LED) lighting treatments, including full spectrum (FS), deep red/white-medium blue (DR/W-MB), and deep red/white-low blue (DR/W-LB), for two additional time intervals. The supplementary LED lighting time intervals (S) applied daily were carried out for 1 h (4:00~5:00 a.m., as S-1) or 2 h (4:00~6:00 a.m., as S-2) from March to September, 2022. Natural light without supplemental lighting was the control. The length of pseudobulb (PL), width of pseudobulb (PW), thickness of pseudobulb (PT), length of inflorescence (FL), number of branches (FB), number of florets (FN), and days to flowering (FD) per plant were recorded andcalculated when 80% of florets became mature. Light treatments significantly affected all pseudobulb growth and flower quality traits at different Gs, especially pseudobulb length (PL) and flower number (FN) under different LED types and lighting time intervals. MB-1 treatment promoted PT at both G3 and G4, whereas MB-2 treatment increased PW at both G2 and G4. Both MB-1 and LB-1 treatments had augmented effects on PL, respectively, at G2 and G3. The PW, FL, FB, and FN increased with additional light time and reached maxima under MB-2 treatment at G4 compared to other treatments and controls. Early flowering and an increased number of flowers at G4 were observed in plants grown under MB-2 treatment. Controlling light quality and supplementary light time intervals enables the production of HA plants with the desired growth and flowering quality characteristics of the pseudobulbs.

Influential factors of the route choices of scooter riders: A GPS-based data study

This study adopted the Global Positioning System records of shared scooter users in Taipei, Taiwan, as study data. Path size correction logit models were applied to clarify the influential factors of the route choices of scooter riders. Results suggest that scooter riders are willing to use safe routes by spending additional travel distances, time, or costs. Scooter riders place a high value on safety, such as avoiding intersections during rush hour and avoiding remote sites at midnight. Notably, this research considered different periods and obtained meaningful findings. Scooter riders pursue speed and are sensitive to crowded environments during the morning peak period, whereas traffic smoothness is their primary consideration during the off-peak period. At midnight, security plays an essential role in route choices, causing scooter riders to approach lighted conditions. The positive influence of right turn density on route choices is a noteworthy discovery and is unlike the results of previous studies on car and bicycle users. This research contributes to the insufficient studies on route choices in the literature by examining the revealed preferences of scooter riders. Its findings can improve existing scooter navigation services and provide a reference to local administrations for designing a scooter-friendly environment.

Expanding Role of Dual-Energy CT for Genitourinary Tract Assessment in the Emergency Department, From the AJR Special Series on Emergency Radiology.

Among explored applications of dual-energy CT (DECT) in the abdomen and pelvis, the genitourinary (GU) tract represents an area where accumulated evidence has established the role of DECT to provide useful information that may change management. This review discusses established applications of DECT for GU tract assessment in the emergency department (ED) setting, including characterization of renal stones, evaluation of traumatic injuries and hemorrhage, and characterization of incidental renal and adrenal findings. Use of DECT for such applications can reduce the need for additional multiphase CT or MRI examinations and reduce follow-up imaging recommendations. Emerging applications are also highlighted, including use of low-energy virtual monoenergetic images (VMIs) to improve image quality and potentially reduce contrast media doses and use of high-energy VMIs to mitigate renal mass pseudoenhancement. Finally, implementation of DECT into busy ED radiology practices is presented, weighing the trade-off of additional image acquisition, processing time, and interpretation time against potential additional useful clinical information. Automatic generation of DECT-derived images with direct PACS transfer can facilitate radiologists' adoption of DECT in busy ED environments and minimize impact on interpretation times. Using the described approaches, radiologists can apply DECT technology to improve the quality and efficiency of care in the ED.

Multicenter Evaluation of the Feasibility of Clinical Implementation of SPECT Myocardial Blood Flow Measurement: Intersite Variability and Imaging Time.

Single-center studies have shown that single photon emission computed tomography myocardial blood flow (MBF) measurement is accurate compared with MBF measured with microspheres in a porcine model, positron emission tomography, and angiography. Clinical implementation requires consistency across multiple sites. The study goal is to determine the intersite processing repeatability of single photon emission computed tomography MBF and the additional camera time required. Five sites (Canada, Italy, Japan, Germany, and Singapore) each acquired 25 to 35 MBF studies at rest and with pharmacological stress using technetium-99m-tetrofosmin on a pinhole-collimated cadmium-zinc-telluride-based cardiac single photon emission computed tomography camera with standardized list-mode imaging and processing protocols. Patients had intermediate to high pretest probability of coronary artery disease. MBF was measured locally and at a core laboratory using commercially available software. The time a room was occupied for an MBF study was compared with that for a standard rest/stress myocardial perfusion study. With motion correction, the overall correlation in MBF between core laboratory and local site was 0.93 (range, 0.87-0.97) at rest, 0.90 (range, 0.84-0.96) at stress, and 0.84 (range, 0.70-0.92) for myocardial flow reserve. The local-to-core difference in global MBF (bias-MBF) was 5.4% (-3.8% to 14.8%; median [interquartile range]) at rest and 5.4% (-6.2% to 19.4%) at stress. Between the 5 sites, bias-MBF ranged from -1.6% to 11.0% at rest and from -1.9% to 16.3% at stress; the interquartile range in bias-MBF was between 9.3% (4.8%-14.0%) and 22.3% (-10.3% to 12.0%) at rest and between 17.0% (-11.3% to 5.6%) and 33.3% (-10.4% to 22.9%) at stress and was not significantly different between most sites. Both bias and interquartile range were like previously reported interobserver variability and less than the SD of the test-retest difference of 30%. The overall difference in myocardial flow reserve was 1.52% (-10.6% to 11.3%). There were no significant differences between with and without motion correction. The average additional acquisition time varied between sites from 44 to 79 minutes. The average bias-MBF and bias-MFR values were small with standard deviations substantially less than the test-retest variability. This demonstrates that MBF can be measured consistently across multiple sites and further supports that this technique can be reliably implemented. URL: https://www. gov; Unique identifier: NCT03427749.

Integration of an App-Based Cognitive Evaluation Program into Radiosurgery Practice: Outcomes and Patient Survey Analysis from a Prospective Observational Study.

Cognitive decline is a significant consequence of stereotactic radiosurgery (SRS) in patients with brain metastases. This is often underrecognized and understudied outside of a formal clinical trial setting as traditional methods are often logistically difficult and need specialized personnel and additional time. To address these challenges, we implemented a prospective study (NCT05504681), incorporating an innovative app-based solution to monitor patient assessments over time, collect patient data easily, and be suitable for cross-cultural use in multiple languages for monitoring post-SRS cognitive decline. Patients undergoing SRS from December 2021 to October 2022 were enrolled in this study and completed feedback surveys. The assessments consisted of learning and memory (Hopkins verbal learning test-revised [HVLT-R]), attention and processing speed (Digit symbols modalities test [SDMT]), verbal fluency (Controlled oral word association test [COWAT]) and executive function (Trail making test [TMT]). Baseline and 3-month follow-up testing were conducted in conjunction with routine imaging and clinical assessments. Neurocognitive deterioration (ND) was defined as a decrease of ≥2 standard errors of the mean in any of the tests, without evidence of new intracranial disease. Any differences between the baseline and follow-up assessments were confirmed using the reliable change index. A total of 30 patients with median age of 68 (range: 47-87) were enrolled. The median KPS was 90 and 60% were female. 43% of participants had a high school or equivalent level of education. 19 (63%) patients were Hispanic and 43% tested in Spanish. The median number of treated lesions was 2 (1-13) and 7 (23%) patients were treated to ≥5 lesions. The median mean left and right hippocampal doses were 0.3 Gy (0-3 Gy) and 0.2 Gy (0-5.2 Gy), respectively. Overall, 50% of patients met criteria for ND at 3 months. 20% of patients showed ND in HVLT-R-immediate recall (IMM), 23% in HVLT-R-delayed recall (DR), 13% in HVLT-R-recognition (Rec), 3% in COWAT and 20% in TMT. None of the patients had ND in SDMT. The mean relative decline was 28% for HVLT-R- IMM, 34% for HVLT-R-DR, 6% for HVLT-R- Rec, 25% for COWAT, and 21% for TMT. There was no significant association between the number of treated lesions and ND. Based on the feedback results, the majority of patients found the system easy to use (94%) and relevant to their care (73%). Most patients reported that app-based evaluation improved discussions with clinicians (77%), made them feel more in control of their care (79%), and they would recommend the system to other patients (87%). Our study showed a high incidence of ND using an app-based tool in a patient who underwent SRS and from diverse education and language backgrounds. Patient survey results demonstrated that the tool was easy to use and relevant to the patient's care, especially due to improvements in discussions with clinicians and a sense of being in control of their own care.

"Show me how to use a microscope" - The development and evaluation of certification as direct assessment of practical lab skills.

Practical lab skills are rarely directly assessed. To improve constructive alignment between the described learning outcomes of practical skills and assessment, we developed and tested a certification procedure for microscopy skills. The procedure was embedded into the ordinary learning activity, so no additional time was needed. Three slightly different protocols were developed within the framework of sociocultural learning theory and built like a skill ladder, including direct peer assessment and elements of gamified learning. The protocols varied slightly in the way students were prepared for the certification, the number of steps/levels of achievement, and the consequences of failing. We tested the protocols at three different academic institutions and within 11 courses of varying sizes and academic levels in biology or geology. Feedbacks were collected through online surveys (n = 207) or orally after sessions. One protocol provided instruction videos as preparation material. Instruction videos provided increased understanding of the task, but tactile training was most important for learning. Regardless of institution, type of preparation, and level of former experience, the certification procedure made students clearly more engaged in the exercise. The majority reported that the certification procedure increased their motivation to learn, increased their perceived learning outcome, and was appropriate for assessing practical skills. Students with no or little experience in microscopy before the exercise were more positive about the certification procedure compared to skilled students, and the level of engagement and preparation was higher when there were some consequences of failing. Most students felt comfortable being certified by peers, but some students expressed concern about peers making mistakes. The presented certification procedure can easily be adapted to assess other practical skills and, with some adjustments, be an efficient method for assessment-as-learning, merging formative- and summative assessment.

Evaluation of the Implementation of Contract Change Order as A Solution to the Problem of Contract Scope Changes

Construction industry activities are increasing. Construction industry players need to be prepared to face the possibility of changes of design planed that are not in accordance with field conditions. The purpose of this research is to identify, analyze the causes and impacts of Contract Change Orders (CCO) at the pre-construction, construction implementation, and post-construction stages with case study is Proyek Simpang Susun Balaraja Timur at Tol Jakarta – Merak, Kabupaten Tangerang. The research method used is descriptive and qualitative methods by conducting Earned Value Analysis and Fishbone Analysis to identify the causal factors and impacts of CCO so that efforts can be made to mitigate the performance of the construction contract from the aspect of quality, cost, and time. The results of the analysis show 3 factors causing CCO namely consultant factors, such as lack of planning preparation and non-compliance with field conditions, project owner factors, and contractor factors. The results of Earned Value Analysis with Estimate at Completion (EAC) calculations can be used to identify the need for additional contract value and additional execution time. On initial contract identification: Cost Performance Index (CPI) is 0.77 (insufficient costs with cost overrun – Rp. 52.502,111,631.83) and Schedule Performance Index (SPI) 1.21, means that Addendum 1 needs to be done with the results: CPI is 1.17 (the costs used are sufficient from the available fees), EAC is Rp. 189,848,751,106.02 with changes in the contract value is Rp. 222,017,999,900.65, SPI is 1.21 from the initial contract value Rp. 174,437,684,167.96

Spatial sampling versus acquisition time of room impulse responses for low-frequency sound zones

Sound zone methods aim to create multiple listening areas within a room, allowing independent playback of different audio content. Achieving this requires a loudspeaker array, multiple microphones per sound zone, and a set of control filters, which design involves the room impulse responses (RIRs) between loudspeakers and microphones. Under certain acoustic conditions, acquiring these RIRs is possible using very short acquisition times. At lower frequencies, longer wavelengths enable spatial sampling of the sound zones with fewer points, reducing the number of microphone positions required and amount of data to process. This study exploits this characteristic to render and evaluate low-frequency sound zones in two real rooms, with few spatial sampling points. We assess the performance by objectively evaluating multiple spatial sampling configurations and RIR acquisition times. Furthermore, we evaluate the system's ability to control sound beyond the sampled regions by assessing the sound field over wider areas. For sound zones roughly the size of a human head, satisfactory performance is achieved in low reverberation conditions with at least two microphones per ear, even for RIR acquisition times as short as 150 μs. Conversely, the performance degradation in highly reflective environments cannot be compensated using additional microphones nor longer acquisition times.

Unsupervised Domain Adaptation via Class Aggregation for Text Recognition

Cross-domain text recognition is a very challenging task due to the domain drift problem. One solution is aligning feature distributions between domains through Unsupervised Domain Adaptation (UDA). All existing methods perform feature alignment based on the whole image or semantic character features. However, visual character features without contextual semantics also contain much valuable information, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">e.g</i> ., stroke features of individual characters, which also benefits domain transfer. To this end, we propose a dual intra-Class Aggregation based unsupervised Domain Adaptation method (CADA) for text recognition, which aligns both visual and semantic character feature distributions. To our knowledge, CADA is the first to consider visual character features without contextual semantics in cross-domain text recognition tasks. Accordingly, a Single-head Self-Attention (SSA) mechanism is introduced for extracting visual character features. Thereafter, a dual intra-class aggregation strategy is designed, which performs class aggregations in both visual and semantic spaces. We test the proposed method on widely-used datasets by combining it with representative text recognition models with various decoding methods. Extensive experimental results demonstrate the superiority and generality. Moreover, there is no additional inference time introduced compared to the baselines.

Autoinduction expression of Bst DNA polymerase using lac operon-controlled expression systems in Escherichia coli

Autoinduction simplified the steps for protein production by omitting the need to monitor the correct time for addition of inducer. This method is preferable for industrially production of protein. By using lac operon-controlled expression system, it is possible to produce the protein without the addition of IPTG as inducer. In a conventional way, IPTG was added at the exponential growth phase. By using autoinduction, IPTG could be replaced by lactose in the lac operon-controlled expression systems. Lactose was already supplemented in the medium and it was more cost efficient than IPTG. Therefore, this study aims to employ autoinduction method for expression of our protein target as it is a more convenient way and it is suitable for industrial application. In this study, DNA polymerase from Geobacillus stearothermophilus (Bst DNA polymerase), an enzyme which generally used in loop-mediated isothermal amplification (LAMP) assay, was expressed using lac operon-controlled expression systems in Escherichia coli. Bst DNA polymerase was successfully expressed using autoinduction expression method in LB medium containing 0.2% Lactose.

Methodological Approaches to Obtaining Informed Consent when Conducting Research With Individuals With Deafblindness

Informed consent is essential in research involving people with disabilities to protect their rights and ensure ethical conduct. Individuals with communicative vulnerability, such as those living with deafblindness, face difficulties when the research process is not accessible. Our team has developed methodological expertise where this vulnerable population is concerned. To formalize recommendations that can improve their inclusion, we utilized an observational, retrospective design to address three questions: What are procedures that facilitate recruitment in a lab specializing on working with individuals living with deafblindness? What are optimal procedural adaptations to obtaining informed consent? and What training can best prepare researchers working with individuals living with deafblindness? First, we conducted a textual narrative synthesis of our eight most recent protocols and procedures that required in-person interaction with adults living with deafblindness. Second, we conducted semi-structured discussions among our team members, and third, we engaged in a validation procedure of the synthesized recommendations with our external partners. Procedural adaptations require flexibility in all aspects of recruitment and consent to accommodate communication needs. These include additional time, and accessible formats. Adaptations should consider vision (e.g., large-print, braille) and hearing (e.g., sign language, communication strategies) as well as aspects unique to deafblindness (e.g., intervener support, tactile communication). Consent can be documented in hand-written, electronic, audio or video-recorded format, and may be facilitated by third parties. Team training should include proficiency in plain language, basic knowledge about deafblindness, and awareness of accessibility features for mainstream devices. We present simple steps that can improve inclusion and increase accessibility for participants living with deafblindness, and that can improve the capacity of the research team by developing flexibility, patience, respect, and trust. This information can further inform institutional ethics review boards that are unfamiliar with the logistics of obtaining informed consent when working with participants living with deafblindness.

A New Marker In The Diagnosis Of Acute Complicated Appendicitis In Adult Patients: Neutrophil/Albumin Ratio

ABSTRACT&#x0D; Aim: Our study aims to search the effectiveness of neutrophil/albumin ratio (NAR) in distinguishing between acute appendicitis (AA) and acute complicated appendicitis (ACA) and to find the best cut-off point of neutrophil/albumin ratio (NAR) for the diagnosis of ACA.&#x0D; Material and method: This study was performed using data from 453 adult patient who underwent appendectomy and divided into two groups as AA and ACA. Demographic data, preoperative white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), neutrophil/albumin ratio (NAR), C-reactive protein value (CRP) surgical outcomes, and pathological outcomes were retrospectively assessed for each groups.&#x0D; Results: In our study, 362 patients were in the AA group and 91 patients were in the ACA group. WBC, NLR, CRP and NAR were significant parameters in differentiating acute appendicitis from acute complicated appendicitis. Among these parameters, NAR; AUROC sensitivity and specificity values were stronger than others. (AUROC: 0.963, sensitivity: 95.6%, specificity: 85.7%). As a result of the ROC curve analysis, a cut-off value of 2.79 mg/dl was found. &#x0D; Conclusion: NAR is a novel inflammatory marker simply detected through routine preoperative blood results, with no additional time or cost. The neutrophil/albumin ratio (NAR) is a fast, easy to access and reliable parameter to differentiate AA from ACA.

STUDY OF INLAND WATERWAY TRANSPORT ROUTING OPTIONS UNDER CONDITIONS OF UNCERTAINTY IN NAVIGATIONAL RESTRICTIONS

Given the uncertainty of the navigating conditions on the Danube River, the hydrological situation on the Bulgarian leg of the river is predicted using ARIMA methods. The forecast is based on statistical daily hydrological data for a period of five years. A mathematical routing model is developed under the condition that it is not possible for a self-propelled vessel to continue its voyage due to draft limitation. Options including waiting for navigation opening, partial lightening on a barge, and a complete or partial modal shift to rail or road transport through an alternative port are considered. An acceptable option is determined, taking into account the additional costs and transit time. A routing simulation is made using SPSS software.

Comparison and Breakdown of Cost in Head and Neck Cancer Radiation Therapy and Adaptive Replanning

Head and neck cancers pose a significant challenge to radiation oncologists due to several factors, including rapid shrinkage during radiation and patient weight loss. As the target and patient anatomy change, re-simulation and re-planning are often necessary, which precipitates additional time, resources, and cost. However, the true added cost of providing adaptive replanning for head and neck cancer patients receiving radiation therapy (RT) is often unknown. We hypothesize that adaptive replanning adds significant cost to treatment, primarily driven by the additional personnel time in the replanning process. The total costs of providing standard radiation therapy and treatment with adaptive replanning for head and neck cancer were calculated using time-driven activity-based costing. We created process maps for each step from consultation to end of treatment, utilizing data that included the space, personnel involved, equipment and supplies used, and time spent. Capacity cost rates were calculated for all resources using a combination of publicly accessible cost data, financial data from our institution, and time averages for each activity obtained from personnel interviews and clinical measurements. We included the following domains in our process maps: consultation, CT simulation, treatment planning, new treatment start, daily beam treatments, weekly on-treatment visits, CT Re-simulation, treatment replanning, and new start for replanned treatment. We found that the total cost for providing standard therapy was $12,216.39 US Dollars (USD), while the total cost of adaptive replanning was $14,705.14 USD, for a relative increase in cost of 20.4%. The most expensive factor for both treatment arms was the cost of daily treatments on the linear accelerator, representing 66.1% and 53.3% of the standard and adaptive replanning, respectively. The second largest driver of cost for both was weekly on-treatment visits with a physician, representing 11.37% and 9.45% of the total cost, respectively. Of the total cost difference between standard therapy and adaptive replanning, 64% was due to personnel costs, 27.9% was due to space/equipment costs, and 8.1% was attributable to material costs. We found that adaptive replanning increased the overall cost of radiotherapy for head and neck cancers by a significant amount. The additional personnel time with resim and replanning, as well as machine time on the CT simulator are the primary reasons for this increase. In addition, use of these resources represents an opportunity cost in the clinic. Opportunities to make adaptive replanning more cost-effective include incorporation of AI tools for volume delineation and/or treatment planning to reduce personnel time, as well as using daily cone beam CT images instead of a new CT simulation, when feasible.

Pengaruh lama perendaman dan penambahan susu skim terhadap karakteristik bubur kacang merah (Phaseolus vulgaris L.) instan

Phaseolus vulgaris L. are a type of legume that is potential and easily available in Indonesia. Processing red kidney beans into instant porridge is an effort to increase the usability of red kidney bean-based products. The purpose of this study was to determine the effect of soaking time of red beans and addition of skim milk to instant red kidney bean porridge based on physicochemical and organoleptic analysis. The research design used in this study is RAK (Group Random Design) consisting of two factors, factor 1: soaking time (12%, 24%, 36%), factor 2: concentrations of skim milk (5% and 10%). The parameters observed are moisture content, ash, protein content, phytic acid, water absorption, swelling, and solubility and organoleptic properties of color, taste, texture, and aroma. The data obtained were analyzed using ANOVA (Analysis of variance) with Tukey's follow-up test 95% confidence level (α&lt;0.05). While sensory tests are carried out with the Friedman Test with a hedonic scale. The results of this study indicate that variations of soaking time and concentrations of skim milk have a significant impact on physicochemical and organoleptic properties are moisture content, ash, phytic acid, protein, water absorption, swelling, solubility, organoleptic parameter (color, texture, and aroma). The best treatment according to the results of physicochemical and organoleptic analysis tests is soaking time 36 hours and concentrations of skim milk 10%, with physicochemical and organoleptic analysis parameters including moisture content 4.28%, ash 1.53%, protein content 8.58%, phytic acid 3.08%, water absorption 5.08%, swelling 568.74%, solubility 29.92%, and organoleptic taste 4.56 (very like), color 4.52 (like), texture 4.60 (very like), and aroma 4.24 (like).

A Comparison of Two Plan Optimization Methods in Three-Dimensional Brachytherapy for Cervical Cancer

To compare dose distributions created by using two Inverse Planning Simulated Annealing (IPSA) and Hybrid Inverse Planning Optimization (HIPO) in three-dimensional (with CT image guidance) brachytherapy planning for cervical cancer. Brachytherapy plans for thirty patients with cervical cancer were created using the IPSA and HIPO algorithms (The IPSA algorithm is calculated based on the anatomical structure, and the simulated annealing algorithm is used to optimize the residence time, and the HIPO algorithm is the optimization and replacement for the IPSA). To obtain a HIPO plan, a manually optimized post-loading treatment plan was applied to these 30 patients, and then the treatment plan was reoptimized using the HIPO algorithm based on the original image information. Individual patients will consider interpolation therapy according to the needs of their condition. The types of plans were compared based on a variety of dose volume parameters, including the mean dose covering 90% of high-risk clinical target volume (D90 for HR-CTV), the mean dose to 2 cm3 volume (D2cc) for bladder, rectum, intestine and sigmoid, and average treatment time were compared and analyzed. Compared with the two groups of plans, mean value of HR-CTV D90 for the HIPO plans was (585 cGy), which was significantly higher than that for the IPSA plans (567 cGy. This difference is statistically significant (P<0.05). The HIPO plans had mean D2cc 422±47 cGy for bladder, 403±38 cGy for rectum, which were lower than those from the SA plans, i.e., 446±42 cGy for bladder and 427±31 cGy for rectum; These differences were statistically significant (t = 5.125, 4.729, P <0.05). There was no statistically significant difference in the sigmoid D2cc doses between the two algorithms. The treatment times for delivering the two types of plans were not significant different. Depending on patient's condition, whether conventional brachytherapy therapy or interpolation therapy is used, the use of the HIPO algorithm to design the treatment regimen without additional treatment time can provide a higher target dose than the manually optimized brachytherapy regimen. Meanwhile, the bladder and rectum doses can be reduced to a certain extent under the premise of ensuring that the target dose met the treatment requirements. There is some increasement for the intestine dose with HIPO planning group, but the dose limits required by the guidelines are still met clinical requirement.

Optimal Fractionation and Timing of Weekly Cone-Beam CT in Daily Surface-Guided Radiotherapy for Breast Cancer

SGRT has been demonstrated as a promising supplement to CBCT in adjuvant breast cancer radiotherapy, but a rational combination mode is lacking in clinical practice. The aim of this study was to explore this mode and investigate its impact on setup and dose accuracy. Both daily SGRT and weekly CBCT images were acquired for 23 breast cancer patients receiving conventional fractionated radiotherapy after lumpectomy. Based on the scanning frequencies and time intervals of CBCT, sixteen modes were acquired by randomly selecting one (CBCT1), two (CBCTij), three (CBCTijk), four (CBCTijkl), and five (CBCT12345) images from the patient's off-line CBCT images for fusion with SGRT. Due to TPS system limitations, the 6D SGRT setup errors were transformed into 3D deviations in the translational directions, and the CTV-PTV margins, the dose coverage (V95%) of PTV and CTV, and the OAR doses (the ipsilateral lung's V5, V10, V20, and Dmean, the contralateral breast's V3 and Dmean, and the heart's Dmean and Dmax) were calculated based on the 3D deviations with different regions of interest (ROIs). Dose correlations between these modalities were investigated using Pearson and Spearman's methods. For the ipsilateral breast ROI, the larger SGRT errors in the AP direction and higher target doses were found in all modes compared to the whole breast ROI (P < 0.05). In the ipsilateral ROI, the CTV-PTV margins decreased as CBCT frequencies increased, reaching approximately 5 mm for CBCTijkl and CBCT12345. The decline of Σ (systematic errors) was greater than the decline of σ (random errors), and it contributed more to the decline of margins. For the same frequency, the CBCT time intervals had essentially little influence on the errors and margins. Compared with other directions, the margins in the SI direction were the largest for all modes except for CBCT124 and CBCT125. The target dose correlations between all modes increased with increasing CBCT time intervals, decreased and then increased with increasing CBCT frequencies, with the turning point observed at week 5 of CBCT participation. The dose deviations in CBCT123, CBCT124, CBCT125, CBCTijkl, and CBCT12345 were minimal and not significantly different (P > 0.05). There was excellent agreement in CBCT124 vs. CBCT1234, and (CBCTijkl, CBCT12345) vs. CBCT125 in determining the classification for the percentage of PTV deviation (Kappa = 0.775-0.901). The frequencies and time intervals of CBCT had little effect on the OAR doses. For all modes, there were strong correlations (R > 0.9) in the OAR doses between different modes, except for the ipsilateral lung's V20 and Dmean (R = 0.734-0.987). Based on weekly CBCT, these modes with the ipsilateral breast ROI and a combination of daily SGRT and CBCT frequencies of ≥ 3 were recommended, and the CBCT was required at weeks 1 and 2. Considering the additional radiation, time consumption, and expensive cost of CBCT, modes CBCT124 and CBCT125 could replace the modes with higher CBCT frequencies.

Running Critical Power: A Comparison Of Different Theoretical Models.

This study aimed (i) to compare the critical power (CP) and work capacity over CP (W´) values reported by the different CP models available in current analysis software packages (Golden Cheetah and Stryd platform), (ii) to locate the CP values in the power-duration curve (PDC), and (iii) to determine the influence of the CP model used on the W´ balance. Fifteen trained athletes performed four time trials (i. e., 3, 5, 10, 20 minutes) to define their PDC through different CP models: work-time (CPwork), power-1/time (CP1/time), Morton hyperbolic (CPhyp), Stryd platform (CPstryd), and Bioenergetic Golden Cheetah (CPCheetah). Three additional time trials were performed: two to locate the CP values in the PDC (30 and 60 minutes), and one to test the validity of the W' balance model (4 minutes). Significant differences (p<0.001) were reported between models for the estimated parameters (CP, W´). CPcheetah was associated with the power output developed between 10 to 20 minutes, CP1/time, CPstryd CPwork and CPhyp. The W´ reported by the three-parameter CP models overestimated the actual 4 minutes time to exhaustion, with CPwork (0.48 [- 0.19 to 1.16] minutes); and CP1/time (0.40 [- 0.13 to 0.94] minutes) being the only valid models (p≥0.240).

Antegrade biliary stenting following surgical management of choledocholithiasis

Background: T-tube drainage of the common bile duct following bile duct exploration has been standard surgical practice for most of the past century. An important drawback of surgical duct exploration and clearance over ERCP is the need for prolonged external biliary drainage via T-tubes and consequently added morbidity. As such interest grew in reassessing the need for T-tube drainage after CBD Exploration. This was especially augmented by increased popularity of laparoscopic CBD exploration at the time of cholecystectomy which could provide a solution to both problems in a single sitting. Methods: This is a prospective observational study. We present a series of 31 cases of open and laparoscopic bile duct exploration where we closed the choledochotomy over an endo-biliary stent which was subsequently removed endoscopically, thus obviating external biliary drainage. Results: In this study 31 patients undergoing CBD exploration at our institution between January 2017 and August 2018 were included after informed consent. These patients underwent primary closure of the CBD over an endobiliary stent without any T-tube. The mean age of the patients was 42 years (36-57 yrs). 19 of the patients were female and 12 were male. The average operating time was 135 min (120-150 min) for open surgery and 160 min (140-170 min) for laparoscopic cases. The average number of days of hospitalization was 5 in laparoscopic cases (4-14 days) and 7 in open surgical cases (6-12 days). The median follow up of patients was up to 18moths years (8 mths-2 yrs). There were no cases of bilioma/intra-abdominal collections requiring drainage. On long term follow up we could not find any clinical/laboratory evidence of development of biliary strictures. Conclusions: Endobiliary stenting after open or laparoscopic bile duct exploration is a safe and attractive option for biliary drainage with many advantages over T-tube and can be achieved with minimal additional skill and operative time.