Daily Checks Research Articles

Responder Safety, Tracking, and Resilience — Georgia, 2016 –2017

ObjectiveTo better understand the importance of monitoring responders during public health emergencies and to learn how the Georgia Department of Public Health (DPH) developed and deployed an electronic responder monitoring tool.IntroductionDuring an emergency, the state of Georgia depends on public health staff and volunteers to respond. It is imperative that staff are safe before, during and after deployment. Emergency response workers must be protected from the hazardous conditions that disasters and other emergencies create1. In October 2016 and September 2017, Hurricanes Matthew and Irma caused widespread evacuation of Georgia residents, initiating a tremendous sheltering effort. Hundreds of public health responders were deployed to assist with sheltering and other aspects of the response. DPH rapidly developed a novel electronic Responder Safety, Tracking and Resilience module, which was used to track public health responders and monitor their health and safety while deployed.MethodsDPH rapidly developed a novel electronic Responder Safety, Tracking, and Resilience module (R-STaR), within the existing State Electronic Notifiable Disease Surveillance System to monitor the health and safety of responders. R-STaR was originally used during Hurricane Matthew, where it was launched the day of the storm, and was launched again four days before Hurricane Irma made landfall. Responders were emailed a web-based link to register, indicating demographic information, contact information, work location, subject area, vaccination status, and whether they considered themselves mentally and physically fit to deploy. Responders then received a daily email with a link to document their daily deployment location, duties, and whether they had any hazardous exposures, illness, or injuries while deployed. A post-deployment survey was sent to responders after Hurricane Matthew to solicit feedback about the responder safety module.ResultsDuring Hurricane Matthew, 128 responders representing 11 Georgia Public Health Districts registered in R-STaR. Seven responders reported illness or injury and were contacted to determine if medical services were needed; all remained healthy post-deployment. During Hurricane Irma, 1240 responders representing DPH and 16 Public Health Districts, and other employers, including law enforcement, fire, and education, registered in R-STaR. Of 472 responders completing daily health checks during their Irma deployment, 48 reported an injury, illness, or exposure, and were contacted to determine if services were needed. The daily health checks led to the identification of an outbreak of influenza in one of the shelters and resulted in vaccination or antiviral prophylaxis administration to 76 responders. Fifty responders to Hurricane Matthew completed the post-deployment survey; 95% found R-STaR easy to use, and 92% indicated that they liked being monitored. Supervisors indicated that the module could be used to: 1) roster and credential responders prior to an event; 2) track where responders are, monitor their health and safety during an event, and quantify the human resources deployed during a declared emergency; and, 3) to distribute post-response responder resources, monitor responder health, and gather information for after-action reports.ConclusionsR-STaR was widely used and well received despite being implemented with no prior training, with a dramatic increase in the number of responders registering from the first implementation in 2016 to the second implementation in September 2017. Monitoring responder health and safety is crucial to responding to and preventing outbreaks during a response, and ensuring responders get appropriate mental and physical support after a deployment. Lessons learned from both events will be used to create a just-in-time training curriculum, and develop a more robust R-STaR, which will enable responder rostering, credentialing, tracking and monitoring before, during, and after an event to ensure the health and safety of our responders as well as for future planning.

Characterization of a multilayer ionization chamber prototype for fast verification of relative depth ionization curves and spread-out-Bragg-peaks in light ion beam therapy.

To dosimetrically characterize a multilayer ionization chamber (MLIC) prototype for quality assurance (QA) of pristine integral ionization curves (ICs) and spread-out-Bragg-peaks (SOBPs) for scanning light ion beams. QUBE (De.Tec.Tor., Torino, Italy) is a modular detector designed for QA in particle therapy (PT). Its main module is a MLIC detector, able to evaluate particle beam relative depth ionization distributions at different beam energies and modulations. The charge collecting electrodes are made of aluminum, for a nominal water equivalent thickness (WET) of ~75mm. The detector prototype was calibrated by acquiring the signals in the initial plateau region of a pristine BP and in terms of WET. Successively, it was characterized in terms of repeatability response, linearity, short-term stability and dose rate dependence. Beam-induced measurements of activation in terms of ambient dose equivalent rate were also performed. To increase the detector coarse native spatial resolution (~2.3mm), several consecutive acquisitions with a set of certified 0.175-mm-thick PMMA sheets (Goodfellow, Cambridge Limited, UK), placed in front of the QUBE mylar entrance window, were performed. The ICs/SOBPs were achieved as the result of the sum of the set of measurements, made up of a one-by-one PMMA layer acquisition. The newly obtained detector spatial resolution allowed the experimental measurements to be properly comparable against the reference curves acquired in water with the PTW Peakfinder. Furthermore, QUBE detector was modeled in the FLUKA Monte Carlo (MC) code following the technical design details and ICs/SOBPs were calculated. Measurements showed a high repeatability: mean relative standard deviation within ±0.5% for all channels and both particle types. Moreover, the detector response was linear with dose (R2 >0.998) and independent on the dose rate. The mean deviation over the channel-by-channel readout respect to the reference beam flux (100%) was equal to 0.7% (1.9%) for the 50% (20%) beam flux level. The short-term stability of the gain calibration was very satisfying for both particle types: the channel mean relative standard deviation was within ±1% for all the acquisitions performed at different times. The ICs obtained with the MLIC QUBE at improved resolution satisfactorily matched both the MC simulations and the reference curves acquired with Peakfinder. Deviations from the reference values in terms of BP position, peak width and distal fall-off were submillimetric for both particle types in the whole investigated energy range. For modulated SOBPs, a submillimetric deviation was found when comparing both experimental MLIC QUBE data against the reference values and MC calculations. The relative dose deviations for the experimental MLIC QUBE acquisitions, with respect to Peakfinder data, ranged from ~1% to ~3.5%. Maximum value of 14.1μSv/h was measured in contact with QUBE entrance window soon after a long irradiation with carbon ions. MLIC QUBE appears to be a promising detector for accurately measuring pristine ICs and SOBPs. A simple procedure to improve the intrinsic spatial resolution of the detector is proposed. Being the detector very accurate, precise, fast responding, and easy to handle, it is therefore well suited for daily checks in PT.

Use of a Mobile App to Facilitate Blood Glucose Monitoring in Adolescents With Type 1 Diabetes: Single-Subject Nonrandomized Clinical Trial.

BackgroundCloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D).ObjectiveThe purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency.MethodsWe used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0%-10.7%, self-monitoring behavior of ≤5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate.ResultsFor mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=–.47, P<.001). Although all participants had positive opinions about the app, its utilization was highly variable.ConclusionsWe demonstrated modest feasibility of adolescents with uncontrolled T1D utilizing a glucose monitoring mobile app. Further study is needed to better determine its effects on BG level and monitoring frequency. Psychosocial factors and motivational barriers likely influence adoption and continuous use of technology for diabetes management.

Investigation of the geometric change of plastic articles made by polyamide

The following paper includes an investigation of the geometric variation of plastic workpieces in a simulated environment of normal climate by 21° / 50% relative humidity. In the industrial manufacturing, the daily quality checks are required to determine, if the plastic workpieces can be released. Due to the humidity or water absorption, the plastic workpiece grows so far that the dimensional accuracy is not given. In this investigation, the results of 12 weeks are determined and presented.

At What Point Is the Accumulated Evidence Sufficient to Change Maintenance Intravenous Fluid Prescribing Practice in Children? How About Yesterday?

It is intriguing and somewhat disturbing that despite intravenous fluids (IVFs) being the most commonly prescribed therapy in hospitalized children, there still seems to be such a wide variation in the approach to choosing what type of intravenous (IV) maintenance fluid to use1,2 and the required monitoring that goes along with it. In this issue of Hospital Pediatrics , Rooholamini et al3 have attempted to address the discrepancy between evidence and practice through a quality improvement project using a standardized pathway to guide the choice of maintenance IVF. Their multidisciplinary approach included creating an evidence-based clinical pathway synthesizing the current consensus with regards to indications of when to start and discontinue IVFs and especially with regards to the optimal tonicity of the IVFs prescribed. They also included standardized monitoring for dysnatremia and signs of fluid overload. I would recommend readers electronically access the clinical pathway described by Romero et al4 because it is well designed with many good principles prominently highlighted (eg, “do not use 1/4 NS for maintenance fluids,” and “pay attention to weight fluctuations ±3%”) and presents the latest evidence in a pragmatic, algorithmic fashion. Those with increased antidiuretic hormone (ADH) secretion risk factors are recommended to receive 0.9% saline, whereas the rest are given 0.45% saline. Some guidance on total IVF maintenance calculation is also given. In the section on monitoring, they have recommended that all children receiving >75% of their maintenance by IVF have their sodium (Na) checked within 24 hours of initiation, but only those on hypotonic fluids require routine daily checks if getting >75% maintenance IVF. Their approach has tried to accommodate perceived gaps and areas of continuing controversy in the evidence (eg, potential adverse effects of isotonic fluids and frequency of Na monitoring). The most relevant and …

Interim check and practical accuracy improvement for machine tools with sequential measurements using a double ball-bar on a virtual regular tetrahedron

This study proposes a method for a quick, simple interim check and practical accuracy improvement of machine tools using just a double ball-bar. The double ball-bar is used to measure sequentially the length of the six sides of a virtual regular tetrahedron within the workspace of the machine tool. Then, the scale and squareness errors of and between the three linear axes are calculated from the length results, and the measured lengths and the calculated errors can be used as criteria for the interim check. The calculated errors can also be compensated for to improve the accuracy of experimented machine tools practically. A sample machine tool was subjected to experimental interim checks applying the proposed method; it showed primarily large length deviations for the six sides due to geometric errors mainly. To improve the geometric accuracy practically, the calculated errors were compensated for and the measurements were repeated, showing significantly improved length deviations for the six sides. The main advantage of the proposed method is that it requires only a double ball-bar and sequential measurements; thus, it is a simple procedure with a measuring time of ∼5 min for a virtual regular tetrahedron. Additionally, the size of the virtual regular tetrahedron can be readily modified by changing the nominal length of the double ball-bar, increasing measurement flexibility. Thus, the proposed method is suitable for quick, simple, cost-effective daily and periodic interim checks, with practical improvement of machine tool accuracy.

Comparing reproductive success of a colonial seabird, the Magellanic Penguin, estimated by coarse- and fine-scale temporal sampling

ABSTRACT Fecundity, an important demographic variable for wildlife populations, is time consuming and expensive to measure. For seabirds, reproductive success is often estimated from 2 surveys of the colony, 1 during incubation and 1 during chick rearing. Using 33 yr of data on Magellanic Penguins (Spheniscus magellanicus), we compared reproductive success estimated from 2 surveys per season, from infrequent nest checks, and from daily nest checks to answer 4 questions: (1) Is reproductive success estimated from 2 surveys per season accurate enough for population models (within 15% of the ‘true' value)? We found that the answer was yes, if surveys were done on optimal dates and chick counts were adjusted by the percentage of chicks that were heavy enough to fledge. Optimal dates depended on the synchrony and phenology of the species. If penguins bred particularly late or early in a given year, estimates were wrong even if counts were done on the average optimal date. (2) Can counts of occupied nests be ad...

Diabetes Self-Management Behaviors among American Indians in the Midwestern United States.

The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.

Partial Incubation During the Egg-Laying Period in the BlackcapSylvia atricapilla

Partial incubation refers to short bouts of incubation during the egg laying period. I determined the occurrence of partial incubation and its association with the number of eggs in the nest at its onset, in the Blackcap Sylvia atricapilla. Additionally, I studied the relationships between the occurrence of partial incubation at a given number of eggs, air temperature and time of day. At each stage of egg-laying, two nest checks were done each day to establish if the clutch was incubated, until 5 eggs were laid; in this study, a clutch of five was a complete clutch. Incubation of one-, two-, three- and four-egg clutches was observed in 0.0%, 34.2%, 72.2% and 95.8%of the nest checks, respectively. Of the two daily checks, incubation was observed only once in 51.8%, 37.0% and 8.3% of two-, three- and four-egg clutches, respectively, for nests with confirmed incubation. There was no relationship between either air temperature or the time of the nest check and whether or not a clutch was incubated. A significant increase in temperature of the eggs occurred only after the fourth egg was laid.

A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control.

Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record

Down-regulation of the liver-derived plasma protein fetuin-B mediates reversible female infertility

Does antisense oligonucleotide (ASO)-mediated down-regulation of serum fetuin-B cause infertility like fetuin-B gene deficiency in female mice? Pharmacological fetuin-B down-regulation by ASO therapy results in reversible infertility in female mice. Female fetuin-B deficient (Fetub-/-) mice are infertile owing to premature zona pellucida (ZP) hardening. Enzyme activity studies demonstrated that fetuin-B is a potent and highly specific inhibitor of the zona proteinase ovastacin, which cleaves ZP protein 2 (ZP2) and thus mediates definitive ZP hardening. Ten fetuin-B ASO boli (100 mg/kg) were injected s.c. over 20 days in 12 female mice, and 10 phosphate-buffered saline (PBS)-treated mice were used as control. At day 20 females were mated to evaluate fetuin-B as a potential molecular target for contraception. ASO and PBS treatment was continued for ten injections. After treatment cessation at day 50, mating was continued to investigate if infertility was reversible. We generated fetuin-B/ovastacin double deficient (Fetub-/-, Astl-/-) mice by conventional breeding to test if fertility of Fetub-/- female mice was restored when the target proteinase would likewise be deleted. At least five matings with each female genotype (Fetub-/- single deficient, Astl-/- single deficient, Fetub-/-, Astl-/- double deficient) were performed. To test the contraceptive effect of fetuin-B down-regulation, 22 female mice (6-13 weeks old) were treated with repetitive boli of 100 mg/kg fetuin-B ASO (n=12) or PBS (n=10) and mated continuously. Serum fetuin-B was determined by immunoblot before, during and after the ASO treatment. After 3 weeks of ASO treatment, in 6 females Fetub mRNA in liver was analyzed by PCR, and six PBS-treated females were used as control. Aspartate (AST) and alanine aminotransferase (ALT) were also measured in serum of six mice in each group. To determine the minimum permissive serum fetuin-B concentration required for successful fertilization IVF was performed in five fetuin-B ASO-treated mice. As a control, six females were injected with control oligonucleotides and six females were left untreated. Fertility of Fetub-/- female mice was restored by additional ovastacin deficiency (Astl-/-). Unlike Fetub-/- mice, female Fetub-/-, Astl-/- mice were fertile, confirming ovastacin as a primary molecular target of fetuin-B. At day 20, after receiving 10 fetuin-B ASO boli, serum fetuin-B was down-regulated to 8±6% (mean ± SD) of baseline level. Fetuin-B down-regulation was confirmed at the mRNA level. Fetuin-B ASO-treated females had 12.1±3.1% of the liver Fetub mRNA level seen in PBS-treated females. In the following mating study, 11 out of 12 mated females failed to become pregnant during 50 days of ASO treatment and continuous mating from day 20 onwards. IVF of oocytes derived from ASO-treated females suggested that a serum fetuin-B level of less than 10 µg/ml was required to prevent pregnancy. Withdrawal of ASO treatment normalized serum fetuin-B and restored fertility; all female mice became pregnant and had litters within 60.3±35.9 days after cessation of ASO treatment. The first litter was significantly smaller than that of control mice (4.6±2.3 versus 6.7±1.8 pups, n=20, P=0.04) but the smaller litter size was only temporary. The size of the second litter was similar to the first litter of control mice (7.6±1.3 versus 6.7±1.8 pups, n=18, P=0.25). The repeated dose of 100 mg/kg fetuin-B ASO boli caused an increased serum ALT and AST activity, suggesting hepatotoxicity. Daily vaginal plug checks indicated successful mating, but mating plugs in ASO-treated mice were less stable (vaginal tract not closed) than in control mice. Pharmacological fetuin-B down-regulation in mice caused reversible infertility. Control of ovastacin proteinase activity by fetuin-B is a necessary determinant of female fertility that can serve as a target for female contraception. Although promising in terms of human contraception, further studies analyzing the balance between sufficient fetuin-B down-regulation and tolerable side effects are required to improve safety before transfer into human reproductive biology can be considered. None. The research was supported by a grant from Deutsche Forschungsgemeinschaft and by the START program of the Medical Faculty of RWTH Aachen University. The authors E.D., J.F. and W.J.-D. are named inventors on a patent application of RWTH Aachen University covering the use of fetuin-B in ovary and oocyte culture. No conflict of interest is declared by C.S. and A.C.

Long-Term Stability of a Portable Carbon Monoxide Single-Breath Diffusing Capacity Instrument.

The 2005 American Thoracic Society/European Respiratory Society guidelines for single-breath diffusing capacity of the lung for carbon monoxide (DLCO) recommend a weekly biological control test and/or DLCO simulator to detect instrument error drift. Very little has been published regarding the results of such a quality assurance program. Our aim was to analyze the long-term stability of a portable DLCO instrument. We used a new EasyOne Pro system and checked its accuracy using a DLCO simulator with 2 reference gases (concentration A: carbon monoxide [CO] = 0.1% and helium = 6.52%; concentration B: CO = 0.08% and helium = 7.21%) during the first 3 y of use in our large clinical laboratory. To detect instrument drift, a healthy woman (MSC), age 43 y old at baseline, tested herself every week during this period of time. More than 6,000 spirometry and 5,000 DLCO maneuvers were done using this instrument for patients during these 3 y. There were no failures in the daily volume and flow checks or the CO and helium calibration checks performed automatically by the instrument. The differences between the simulator DLCO and the measured DLCO were -0.91 ± 1.33 mL/min/mm Hg and -0.61 ± 1.45 mL/min/mm Hg for concentration A and concentration B, respectively. The results of the 110 biological control tests were: mean 30.8 ± 1.7 mL/min/mm Hg (95% CI 30.5-31.1), coefficient of variation of 5.4% in DLCO, and repeatability of 2.5 mL/min/mm Hg. Only 4 measurements were outside ±3 mL/min/mm Hg (3.6%). Her mean alveolar volume was 4.2 ± 0.25 L with coefficient of variation of 6.2%; her inspired volume was 3.05 ± 0.14 L, and coefficient of variation = 4.5%. Measurements of DLCO were stable over the 3-y period without any need for manual recalibration of the instrument. The biological control was as good as the DLCO simulator to evaluate this kind of device in a long-term laboratory quality control program.

A simple PMMA phantom for daily QA energy checks in proton therapy

Introduction Beam energy measurements are one of the most important data that every radiotherapy facility has to collect periodically as constancy check. In proton therapy, due to the energy selection system and to the shape of the Bragg peak, this check has to be performed daily. Purpose To demonstrate that reliable daily proton energy verification is achievable using a 2D array of ionization chambers (IC) combined with our PMMA phantom. Material and methods The PMMA phantom is provided with three couples of wedges: thanks to these, Bragg peak is sampled at different depths and the image becomes a transposition on the transverse plane of the depth dose. Coupled wedges are necessary to compensate for set-up errors. Three wedges of different slopes (the first and lowest one is for energy from 70 to 100 MeV, the middle one from 100 to 140 MeV and the third and highest one from 140 to 226 MeV) are used to spread the depth dose of every single checked energy in a way that the distal penumbra can be properly detected by an adequate number of IC in the 2D Array device. Results A sensitivity test showed that the phantom is able to detect range variations greater than the threshold (2 mm). Conclusions We designed and built a reliable phantom for the range verification. Moreover, the costs of this phantom are very low compared to other commercial solutions used for range verification in proton therapy.

Dosimetric characterization of a commercial 2-D scintillation detector for quality assurance tests in scanned proton and carbon ion beams

Introduction Pencil beam scanning technique used at CNAO requires beam characteristics to be carefully and periodically checked to guarantee patient safety. Radiochromic films are used within daily QA checks. Purpose This study aimed at characterizing the Lynx PT system (IBA Dosimetry) and assessing its suitability for QA tests, for proton and carbon ion beams. Materials and methods The Lynx PT is a 2D high-resolution dosimetry system consisting of a scintillating screen coupled with a CCD camera, in a compact light-tight box. A dedicated software is used for image acquisition, raw data correction and fast data analysis. Lynx was characterized in terms of short-term stability, image geometrical distortion, uniformity, signal proportionality, response dependence on IRIS and on particle intensity, particle energy and type. Irradiations were performed at the Centro Nazionale di Adroterapia Oncologica (CNAO) for both protons and carbon ions. Measurements with Lynx were compared to those made with EBT3 reference films. The detector response dependence on radiation LET was also investigated. Results Lynx basic characterization results have shown a proportional behavior with delivered number of particles. Strong dependence of the acquired signal on beam energy and particle type was found. No significant differences in the investigated beam parameters measured with Lynx and EBT3 film were observed. The detector also showed good performances in term of image uniformity and geometrical distortion. Conclusion The Lynx PT system appears as a promising tool for measurements for both single pencil beam and scanned beam, enabling fast QA and beam optics optimization checks.

Karin Bornfeldt

Karin Bornfeldt is stubborn. Once she gets curious about something, she does not let it go—turning questions around in her head, examining the issue from varying perspectives, thinking about alternative solutions, and applying a variety of tools to the problem. The question that sparked Bornfeldt’s curiosity during her PhD research at the University of Linkoping was how diabetes mellitus accelerates atherosclerosis. She has never lost interest, and in 3 decades of research, she has worked to uncomplicate the most deadly of diabetic complications. Bornfeldt, joint professor of medicine and pathology at the University of Washington in Seattle, arrived at the university in 1991 as a postdoc to work with Russell Ross, PhD, and Edwin Krebs, MD. She joined the faculty in 1995 and is now associate director of the Diabetes and Obesity Center of Excellence, deputy director of the Diabetes Research Center, and director of the Viral Vector and Transgenic Mouse Core at the university. Karin Bornfeldt When Bornfeldt established her independent laboratory in 1997, she recognized the need for a mouse model of diabetes mellitus–accelerated atherosclerosis that could separate the effects of diabetes mellitus per se from the effects of diabetes mellitus–induced hyperlipidemia. The laboratory created a transgenic mouse that develops type 1 diabetes mellitus in a process similar to that of type 1 in humans, with viral infection inducing T-cell–mediated destruction of beta cells, and also develops atherosclerosis. Using that model, the team showed that, even with no lipid abnormalities or cholesterol in the diet, diabetes mellitus accelerates the initiation of atherosclerotic lesions by stimulating macrophage accumulation within the vascular wall. In contrast, when the mice are fed a cholesterol-rich diet and then given diabetes mellitus, they develop severe hypertriglyceridemia and advanced atherosclerotic plaques.1 Later, when the team induced type 1 diabetes mellitus in mice after they …

Do youth with type 1 diabetes exercise safely? A focus on patient practices and glycemic outcomes.

Insulin adjustments have been shown to reduce glycemic excursions during and after exercise, but little is known about their use in youth with type 1 diabetes (T1D). We aimed to assess practices in youth with T1D around exercise, assess factors that influence practices, and examine associations between key behaviors and glycemic outcomes. We developed the 'Type 1 Diabetes Report of Exercise Practices Survey (T1D-REPS)' and piloted this tool in 100 youth with T1D on an insulin pump. Participants completed a 3-day physical activity recall and 30 days of pump/glucose data were collected. Chart review was conducted for key clinical measures. Eighty-four percent of participants modified their insulin regimen around exercise; only 40% reported adjusting prandial insulin immediately before exercise while 68% reported some modification (suspension or decrease) of basal insulin during exercise. Following exercise, only 10% reported reducing overnight basal insulin. Those who performed ≥ 5 glucose checks/day adjusted basal insulin during exercise more frequently than those with fewer daily glucose checks (33% vs. 13%, p = 0.05, chi-squared = 3.7), and were more likely to report decreasing insulin dose for the bedtime snack following exercise (50% vs. 17%, p = 0.004, chi-squared = 8.2). Despite several studies showing the frequency of hypoglycemia during and after exercise, many youth are not adjusting insulin for exercise. A tool designed to capture patient practices and provide clinicians with a framework for patient education may lead to improved safety around exercise in youth with T1D.

The Relation of Questionnaire and Performance-Based Measures of Executive Functioning With Type 1 Diabetes Outcomes Among Late Adolescents.

Successfully managing Type 1 diabetes involves adherence to a complex daily medical regimen, requiring self-regulatory skills that rely on neurocognitive processes known as executive functioning (EF). Adolescents with poorer rated EF abilities display poorer diabetes outcomes. The purpose of this study was to examine the relationship of EF questionnaire and performance measures with adherence and glycemic control, after controlling for IQ and general questionnaire response style. Adolescents with Type 1 diabetes (M age = 17.74, SD = .38 years) and their mothers (N = 196) completed a self/mother-report questionnaire assessing adolescents' ratings of EF abilities (Behavior Rating Inventory of Executive Functioning-Self-Report). Adolescents also completed performance-based tests of EF (Delis-Kaplan Executive Function System) and intellectual functioning (Wechsler Adult Intelligence Scale, 4th ed., Vocabulary). Adherence was indexed via 2 self-report inventories and the number of daily blood glucose checks, and glycemic control via HbA1c obtained from assay kits. Self/mother-reports of EF ability were associated with self/mother-reported adherence. Both questionnaire and performance-based measures of EF were associated with glycemic control. However, once IQ was taken into consideration, performance-based EF was no longer associated with glycemic control; IQ independently shared variance with glycemic control. Our findings suggest that self-reports of EF may be useful in identifying late adolescents who need assistance in managing diabetes in daily life. The finding that performance-based EF measures were not related to glycemic control independent of underlying intellectual capacity raises questions about the specific role of EF in diabetes outcomes. (PsycINFO Database Record

Histological features of the placenta and their relation to the gross and data from Thoroughbred mares

Abstract: The placenta is a transitory organ that originates from maternal and fetal tissues, the function of which is transporting nutrients from the mother to the fetus. The aim of this study was describe the histological features of placentas in healthy Thoroughbred mares at foaling and evaluate their relation with the gross placental and data of these mares. For this study 188 Thoroughbred mares were used. It was performed clinical observation for signs of placentitis during daily health checks and ultrasonic examination monthly to assess the fetus and placenta. All of the mares that exhibited clinical signs of placentitis were treated during gestation. The parturition was assisted, the placentas were grossly evaluated and samples were collected immediately after expulsion. The following data were considered for each mare: age, gestational age, number of parturition, time for placental expulsion, umbilical-cord length, placental weight and clinical signs of placentitis. Histological evaluation of the placentas revealed extensive cytoplasmic vacuolization of the epithelial areolar cells, presence of inflammatory infiltrates and hypoplasia-atrophy of the microcotyledons. Most of the gross placental findings were consistent with the histological results. In conclusion the mares with a vacuolated placental chorionic epithelium were older and had experienced a larger number of births. Great part of the mares with inflammatory infiltrates did not showed any clinical signs of placentitis during gestation.

SU‐F‐T‐470: Implementation of a Daily Quality Assurance Phantom for Six Degrees‐Of‐Freedom Couch Testing

Purpose:To develop a daily quality assurance (QA) device that can test the 6DoF (degrees of freedom) couch repositioning accuracy, prior to SBRT treatment deliveries, with an accuracy of ±0.3 degrees and ±0.3 mm.Methods:A daily QA phantom is designed with a focus on the derived center of projections of its markers, rather than tracking its individual markers one at a time. This approach can be the most favorable to address the intended machining accuracy of the QA phantom and the CBCT spatial resolution limitations, primarily 1 mm min slice thickness, simultaneously. With the current design, ±0.1 mm congruence of the resultant center of gravity of the markers with reference CT (0.6 mm minimum slice thickness) vs CBCT (1.0 mm minimum slice thickness) can be achieved. If successful, the QA device should be qualified to test 6DoF couch performance with a gauged accuracy of ±0.3 degrees/±0.3 mm. Testing is performed for the Varian True Beam 2.0 6DoF system.Results:Once the QA phantom is constructed and tested, agreement of the center of gravity of the reference CT scan and the CBCT scan of ±0.1 mm is achieved. This has translated into a consistent 3D‐3D match on the treatment machine, CT vs CBCT, with a repetitive ±0.1 mm variation, thus exceeding our expectations. We have deployed the phantom for daily QA on one of our accelerators, and found that the QA time has increased by only 10 minutes.Conclusion:A 6DoF phantom has been designed (patent pending) and built with a realistic work flow in mind where the daily couch accuracy QA checks taking less than 10 minutes. Current developments include integration with the Varian's Machine Performance Check consistency module.

Preliminary Retrospective Analysis of Daily Tomotherapy Output Constancy Checks Using Statistical Process Control.

The purpose of this study was to retrospectively evaluate the results from a Helical TomoTherapy Hi-Art treatment system relating to quality controls based on daily static and dynamic output checks using statistical process control methods. Individual value X-charts, exponentially weighted moving average charts, and process capability and acceptability indices were used to monitor the treatment system performance. Daily output values measured from January 2014 to January 2015 were considered. The results obtained showed that, although the process was in control, there was an out-of-control situation in the principal maintenance intervention for the treatment system. In particular, process capability indices showed a decreasing percentage of points in control which was, however, acceptable according to AAPM TG148 guidelines. Our findings underline the importance of restricting the acceptable range of daily output checks and suggest a future line of investigation for a detailed process control of daily output checks for the Helical TomoTherapy Hi-Art treatment system.