Relevant Discrepancies Research Articles

SOME ISSUES CONCERNING UNIFICATION AND HARMONIZATION OF EUROPEAN FOUNDATION LAW

The European Union needs unified legislation regulating private juridical relations in the fields of property rights, contracts, torts and status of legal entities (companies and non-profitable organizations) etc. all over Europe. However it is still complicated to harmonize and unify law of inheritance and family law, as these spheres are not connected with the internal market and Member States have their particular traditions in this field. As we know, according to the Article 95 of the EC Treaty, the approximation of the provisions laid down by law should have as their object the establishment and functioning of internal market. European Civil Code lacks in sound foundation and sufficient grounds. Therefore the codification appears to be premature whereas the unification of single institutes of private law seems to be reasonable and timely. In particular, must be unified the institute of foundations and rules governing their activities. The European foundation sector is a major economic force and makes significant contributions to the public good of Europe. If we refer to the foundation law of EU countries, as long as there are no suitable directives or decisions aimed at harmonizing of standards concerning the foundations (a project of European Foundation Statute has not been adopted yet), there are less relevant discrepancies. European Foundation Statute would provide further benefits to the foundation sector. It would help to clarify terms and the concept of foundations as organizations with their own resources and independent governance. It would also help to develop a common definition of “public benefit purpose” foundations, as currently the term “foundation” is much too loosely used. But now within the EU each Member State has a slightly different understanding of what foundations are. There are legal barriers to cross-border activities of foundations of the Member States both in civil law and in tax law. As in company law, most of the barriers can be overcome, but this leads to compliance costs which will often be higher than they would be in company law, given that the legal and personal environments vary (foundation and tax laws of the Member States seem to have more legal uncertainties inter alia because of much less case law and fewer specialized lawyers, and because board members of foundations may be less experienced in legal issues). A European Foundation Statute will become a law, which would do much to overcome the barriers which impede foundations’ cross-border activities. The Statute would have the effect of unleashing foundations’ potential economic impact on public-good activities.DOI: http://dx.doi.org/10.5755/j01.eis.0.5.1082

NEW ALGORITHMS FOR THE SPECIFIC ABSORPTION RATE NUMERICAL EVALUATION BASED ON SPHERICAL AVERAGING VOLUMES

The numerical calculation of the Speciflc Absorption Rate (SAR) averaged over a certain tissue mass is a common practice when evaluating the potential health risk due to the human exposure to electromagnetic sources. Nevertheless, SAR values are strongly in∞uenced by many factors such as, for instance, the shape of the volume containing the reference mass, the spatial discretization step, or the treatment of internal air, just to mention some of them: difierent choices can induce signiflcant discrepancies. In this work, an overview on some of the most commonly adopted SAR algorithms is flrstly presented, and a discussion on their potential difierences reported. Then, based on a spherical volume approach, some new algorithms are proposed. All the algorithms are then used to evaluate the SAR both in artiflcially generated test cases and in some practical human-antenna interaction problems. The result comparison highlights relevant discrepancies and enforces the necessity of a reasoned standardization of the techniques for the SAR calculation.

Evaluating and improving semi-analytic modelling of dust in galaxies based on radiative transfer calculations - II. Dust emission in the infrared

Interstellar dust grains are responsible for modifying the spectral energy distribution (SED) of galaxies, both absorbing starlight at UV and optical wavelengths and converting this energy into thermal emission in the infrared. The detailed description of these phenomena is of fundamental importance in order to compare the predictions of theoretical models of galaxy formation and evolution with the most recent observations in the infrared region. In this paper we compare the results of GRASIL, a code explicitly solving for the equation of radiative transfer in a dusty medium, with the predictions of a variety of IR template libraries. We employ star formation history samples extracted from the semi-analytical galaxy formation model MORGANA to create libraries of synthetic SEDs from the near- to the far-infrared. We consider model predictions at different redshift ranges to explore any possible influence in the shape and normalization of the SEDs due to the expected evolution of the galaxy properties. We compute the total absorbed starlight predicted by GRASIL at optical wavelengths to statistically compare the synthetic SEDs with the selected IR templates. We show that synthetic SEDs at a given total infrared luminosity are predicted to be systematically different at different redshift and for different properties of the underlying model galaxy. However, we determine spectral regions where the agreement between the results of radiative transfer and IR templates is good in a statistical sense (i.e. in terms of the luminosity functions). Moreover, we highlight some potentially relevant discrepancies between the different approaches, both in the region dominated by PAH emission and at sub-mm wavelengths. These results determine potentially critical issues in the infrared luminosity functions as predicted by semi-analytical models coupled with different IR flux estimators.

MRNA and microRNA Expression Profiles in Circulating Tumor Cells and Primary Tumors of Metastatic Breast Cancer Patients

Molecular characterization of circulating tumor cells (CTC) holds great promise. Unfortunately, routinely isolated CTC fractions currently still contain contaminating leukocytes, which makes CTC-specific molecular characterization extremely challenging. In this study, we determined mRNA and microRNA (miRNA) expression of potentially CTC-specific genes that are considered to be clinically relevant in breast cancer. CTCs were isolated with the epithelial cell adhesion molecule-based CellSearch Profile Kit. Selected genes were measured by real-time reverse transcriptase PCR in CTCs of 50 metastatic breast cancer patients collected before starting first-line systemic therapy in blood from 53 healthy blood donors (HBD) and in primary tumors of 8 of the patients. The molecular profiles were associated with CTC counts and clinical parameters and compared with the profiles generated from the corresponding primary tumors. We identified 55 mRNAs and 10 miRNAs more abundantly expressed in samples from 32 patients with at least 5 CTCs in 7.5 mL of blood compared with samples from 9 patients without detectable CTCs and HBDs. Clustering analysis resulted in 4 different patient clusters characterized by 5 distinct gene clusters. Twice the number of patients from cluster 2 to 4 had developed both visceral and nonvisceral metastases. Comparing transcript levels in CTCs with those measured in corresponding primary tumors showed clinically relevant discrepancies in estrogen receptor and HER2 levels. Our study shows that molecular profiling of low numbers of CTCs in a high background of leukocytes is feasible and shows promise for further studies on the clinical relevance of molecular characterization of CTCs.

Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers

The random use of point-of-care, blood gas and core laboratory analyzers to measure electrolytes and metabolites increases the variability in test results. This study was designed to determine whether these results performed on whole blood (point-of-care and blood gas) and plasma (core laboratory) platforms are interchangeable without a risk of clinically relevant discrepancies. The interchangeability of the blood gas analysis, electrolytes, glucose, lactate and hemoglobin results performed with three stat platforms (i-STAT, Radiometer ABL 825, RapidLab 865) and two core laboratory platforms (Roche Modular P800 and Sysmex XE-2100) were evaluated using samples from critically ill patients. For pH, pCO(2), pO(2) and Ca(2+), good correlation (r-values 0.96-1.00) was observed for all comparative analyzers and the biases were within clinically acceptable limits. Potassium, sodium, glucose, lactate and hemoglobin measured with stat analyzers was highly correlated with measurements performed using the laboratory analyzers, r-values 0.89-1.00 and slopes 0.83-1.07. Mean differences with significant bias (p<0.0001) were found for sodium with blood gas analyzers and hemoglobin with i-STAT. The blood gas, K(+), Na(+), Ca(2+), glucose and lactate results measured with stat and core laboratory analyzers can be used in different clinical settings for critical care management. However, when monitoring small changes in sodium concentrations, the use of single analyzer is encouraged to avoid analytical differences (acceptance limit ± 2%) and misinterpretation of results measured with multiple analyzers. The users of the i-STAT at low hemoglobin values overdiagnose anaemia. Thus, prior to transfusion, the use of hemoglobin concentrations measured with laboratory analyzers is preferable.

The Relation between Investor Protection and Equity Markets Development in Emerging Economies: A Study of the Bullish Period between 2003 and 2007

Financial intermediation plays a key role in the economic organization of nations as financial agents are capable of relaxing the underlying market imperfections and frictions that make exchanges extremely costly to a level that they would simply not be performed in their absence. A long lasting debate in the literature has opposed the advocates of bank-centred systems to the advocates of market-centred systems. In the late 1990s, a series of papers by La Porta. Lopez-de-Silanes, Shleifer Vishny (henceforth LLSV), accompanied by studies from Levine (1997, 1999b), Barth, Caprio and Levine (2000) and others, have suggested and demonstrated with empirical evidence that establishing a legal environment that credibly protects the rights of investors is much more important than considerations regarding bank-based or market-based systems. LLSV (1997, 2008) have also demonstrated that the origins of the legal system influence investor protection and the development of stock markets, showing that English origin countries are the most financially developed and French Origin countries are the worst. Djankov et al. (2008) has developed an anti-self-dealing index for 72 countries to classify them according to their level of investor protection. These series of papers by various authors have changed the focus of the debate, redirecting it to the relation between corporate governance, investor protection and the development of financial markets. To understand how investor protection influences financial development is quite important given that this is the most obvious potential channel of influence of investor protection on growth. The present work intends to analyze how different levels of investor protection measured by the anti-self-dealing index (Djankov et al.) and also how legal origins have affected the stock market development in emerging and developed economies in the period between 2003 and 2007. Given their institutional framework (generally weaker than developed economies) and the fact that they compose a more diversified range of countries with various levels of development, emerging markets constitute an interesting group to study the impact of different levels of investor protection as this element can be the cause of particularly relevant discrepancies. Results confirm that investors protection have an effect on the depth of financial markets and show that the relation has worked differently in emerging economies in comparison to developed countries in the period studied. There is indication that the level of investor protection is even more important in emerging markets, although significant differences are only felt between very high and very low protection economies, whereas in developed markets higher protection stock markets have performed worse in the period. In terms of legal origin, a surprising finding was that in the period between 2003 and 2007 ‘French origin’ economies have performed better than ‘English origin’, although the indicators of financial depth still show that ‘English origin’ countries have more developed stock markets.

Abstract P3-02-05: Evaluation of Gene Transcripts in Primary Tumors at Time of Diagnosis and Circulating Tumor Cells (CTCs) at Time of Metastatic Disease

Abstract Introduction: The enumeration of CTCs has already shown to bear clinical relevance as a prognostic and predictive factor in metastatic breast cancer. In addition to enumeration, isolation of CTCs enables their molecular characterization and thus holds great promise to establish association of their genetic profile with patient outcome and to identify potential drugable targets. In this study we established epithelial-specific mRNA and microRNA profiles in CTCs of patients with metastatic breast cancer, compared these profiles to the profiles measured in corresponding primary tumors, and determined their association with clinical parameters. Study design: For this study we included 50 breast cancer patients, of which 32 presented themselves with over 5 CTCs at the time of metastatic disease. From 14 of these patients with more than 5 CTCs at the time of metastatic disease also the primary tumor at time of breast cancer diagnosis was evaluated. Total RNA was extracted 1) from blood of the 50 patients with metastatic disease after EpCAM-based enrichment of 7.5 mL whole blood with the CellSearch™ Profile Kit [Veridex LCC], 2) from 14 unprocessed whole blood preparations from healthy blood donors, and 3) from 14 primary tumors. Gene transcript levels of CTC-specific and potentially clinically relevant mRNAs and microRNAs were compared in CTCs isolated at time of metastatic disease and the corresponding primary tumors. In addition, the association of these transcript levels with clinical data was assessed. Results: We identified 24 mRNA and 14 microRNAs more abundantly expressed in CellSearch-enriched fractions from patients with at least 5 CTCs compared with those without CTCs and/or compared with unprocessed whole blood prior to CellSearch enrichment (Mann-Whitney U-test P&amp;lt;0.05). In addition, when comparing transcript levels present in CTCs during metastatic disease and those measured in the corresponding primary tumor, potentially clinically relevant discrepancies were observed. Findings of interest included changes in transcript levels of genes such as ESR1, ERBB2, TOP2A and MGB1, and in genes associated with proliferation and EMT. Finally, associations were observed between transcript levels measured in CTC preparations and clinical data like nodal status and size of the primary tumor. Conclusion: Our results show that molecular characterization of CTCs is feasible and has potential for a more tailored clinical approach above CTC enumeration in the treatment of metastatic breast cancer patients. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-02-05.

Decreased immunoexpression of survivin could be a potential marker in human non-alcoholic fatty liver disease progression?

Regulation of apoptosis in non-alcoholic fatty liver disease (NAFLD) has been a theme of growing debate. Although no other study assessed the role of survivin in NAFLD, its expression has been reported in hepatic carcinogenesis because of other aetiological factors with relevant discrepancies. The aim of this study was to assess the pattern of survivin immunoexpression by tissue microarray along the whole spectrum of NAFLD, including non-alcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC). Liver biopsies from 56 patients with NAFLD were evaluated: 18 with steatosis, 21 non-cirrhotic NASH, 10 NASH-related cirrhosis, seven NASH-related HCC, as compared with 71 HCC related to other causes and with 12 normal livers. Survivin immunoexpression in NAFLD was restricted to cytoplasm and was found to be progressively lower in advanced stages, including cirrhosis and HCC: steatosis vs NASH-related cirrhosis (P=0.0243); steatosis vs NASH-related HCC (P=0.0010); NASH vs NASH-related cirrhosis (P=0.0318); and NASH vs NASH-related HCC (P=0.0007), thus suggesting a deregulation of apoptosis from NAFLD towards HCC. Interestingly, survivin immunoreactivity in NASH-related HCC was also found to be significantly lower than in HCC related to other causes (P<0.05). Remarkably, nuclear staining for survivin was not detected in any case of NAFLD, contrasting to its presence in all other cases of HCC. Survivin immunoexpression in NASH-related HCC is herein originally found substantially different than in HCC related to other causes, thus requiring further studies to elucidate the role of survivin in human NAFLD progression.

Comparability of haemoglobin mass measured with different carbon monoxide-based rebreathing procedures and calculations

Background. Measurements of haemoglobin mass (Hbmass) with the carbon monoxide (CO) rebreathing method provide valuable information in the field of sports medicine, and have markedly increased during the last decade. However, several different approaches (as a combination of the rebreathing procedure and subsequent calculations) for measuring Hbmass are used, and routine measurements have indicated that the Hbmass differs substantially among various approaches. Therefore, the aim of this study was to compare the Hbmass of the seven most commonly used approaches, and then to provide conversion factors for an improved comparability of Hbmass measured with the different approaches. Methods. Seventeen subjects (healthy, recreationally active, male, age 27.1 ± 1.8 y) completed 3 CO-rebreathing measurements in randomized order. One was based on the 12-min original procedure (COoriginal), and two were based on the 2-min optimized procedure (COnew). From these measurements Hbmass for seven approaches (COoriginalA-E; COnewA-B) was calculated. Results. Hbmass estimations differed among these approaches (p < 0.01). Hbmass averaged 960 ± 133 g (COnewB), 981 ± 136 g (COnewA), 989 ± 130 g (COoriginalE), 993 ± 126 g (COoriginalA,D), 1030 ± 130 g (COoriginalB), and 1053 ± 133 g (COoriginalC). Procedural variations had a minor influence on measured Hbmass. Conclusions. The relevant discrepancies between the CO-rebreathing approaches originate mainly from different underlying calculations for Hbmass. Provided Hbmass enabled the development of conversion factors to compare average Hbmass values measured with different CO-rebreathing approaches. These factors can be used to develop reasonable Hbmass reference ranges for both clinical and athletic purposes.

Differences in serum thyroglobulin measurements by 3 commercial immunoradiometric assay kits and laboratory standardization using Certified Reference Material 457 (CRM‐457)

Serum thyroglobulin (Tg) is essential in the follow-up of patients with differentiated thyroid carcinoma (DTC). However, interchangeability and standardization between Tg assays have not yet been achieved, even with the development of an international Tg standard (Certified Reference Material 457 [CRM-457]). Serum Tg from 30 DTC patients and serially diluted CRM-457 were measured using 3 different immunoradiometric assays (IRMA-1, IRMA-2, IRMA-3). The intraclass correlation coefficient (ICC) method was used to describe the concordance of each IRMA to CRM-457. The serum Tg measured by 3 different IRMAs correlated well (r > .85, p < .0001), but clinically relevant discrepancies were found in 13.3% of patients. IRMA-3, which claims to be standardized to CRM-457, showed the best ICC (p(1) = .98) for the CRM-457. Hospitals caring for patients with DTC should either set their own cutoffs for IRMAs for Tg based on their patient pools, or adopt IRMAs standardized to CRM-457 and calibrate their laboratory using CRM-457.

Catamenial pneumothorax

Although known for several decades, catamenial pneumothorax has been considered until recently as an extremely rare entity. The condition is now more easily recognized and several studies have been published, with somewhat relevant discrepancies with respect to etiologic, epidemiologic, and management features. In the present review, I will provide a synthesis of available knowledge on the subject. Catamenial pneumothorax accounts for approximately one third of cases of spontaneous pneumothoraces in women referred for surgery. At video-assisted thoracic surgery, diaphragmatic defects and nodules are the most frequent findings. Pathology shows endometriosis in most instances. Endometrial implants in visceral pleura are also found, although less frequently. Findings of surgical explorations support the theory of transabdominal-transdiaphragmatic passage of air to explain the pathogenesis of catamenial pneumothorax. Management of patients with catamenial pneumothorax implies surgery, if possible by video-assisted technology, to obtain samples for pathologic confirmation of endometriosis and to treat the main pathogenic mechanisms of pneumothorax. Partial diaphragmatic resection and/or exeresis of visceral pleural implants, as well as talc pleurodesis, are nowadays frequently carried out. Medical therapy to achieve ovarian rest is mandatory in the postoperative period, the multimodality management being the key to treatment success in this condition.

Syphilis serology: Seroprevalence in a selected population and considerations on the Euroline WB test

Introduction: The clinical diagnosis of syphilis is always supported by appropriate laboratory tests and the test results are interpreted with reference to the patient’s history. In the diagnosis of syphilis, the use of tests based on antibody search that recognize both treponemal and reaginic antigens increases the diagnostic chances. Our study discusses the various serological and alternative tests currently available along with their limitations, and relates their results to the likely corresponding clinical stage of the disease. Methods: in our laboratory were analyzed 264 sera and 4 liquor (123 Females, 145 Males). 187 patients are subject at low risk for luetic infection, including pregnant woman, patient with organ transplant, outpatients or hospitalized undergoing routine serological, and 81 from patients with confirmed syphilis including 4 pregnant women in antibiotic treatment, patients with suspected disease, HIV positive and patients with autoimmune diseases with Cardiolipin positive. All sera were tested with ELISA Anti-Treponema pallidum Screen (IgG / IgM) and in parallel with agglutination tests VDRL and TPHA. On all positive sera was tested Euroline-WB EUROIMMUN and reading done with the program EuroLineScan. Results: by ELISA Anti-Treponema pallidum Screen IgG / IgM 162 sera were negative and 106 sera positive (39.5%), distributed as follows: 45 (42%) with a value greater than 200 RU / ml, 43 (41% ) with a value&gt; 22 RU / ml and 18 (17%) with a borderline value between&gt; 16 to &lt;22 RU / ml. The execution of the Blot IgG showed: 18 negative sera, 6 with borderline value with one only band of specific antigens (p15, p45, p47 or p17), while 82, including 4 liquor (neurolue), were certainly positive showing more than one band antibody to the treponemal antigens. Only one patient had in place at the time of screening, an initial infection; in fact, there was a single clear positivity in the IgM protein bands, while 7 sera was uncertain values. It is reported 11 positivity for IgM Cardiolipin, while Cardiolipin IgG was detected with a high positivity in 34 sera. The presence of borderline values and / or positivity for a single protein band can be attributed to a unspecific reaction caused by autoimmune diseases or related cross-reactions with other Spirochete or to other Borrelia. Conclusions: The immunoblot test gave useful information at epidemiological and clinical level. The deepening with a confirmation test with proteic antigens and cardiolipin identifies false reactivity, but also indicates the specific reactivity to past infection and a better characteriation in the different stages of disease. In our study in the latent forms there are relevant discrepancies among the various tests. Compare to traditional methods, anti-cardiolipin antibodies positivity in our confirmatory test has the advantage of providing non subjective interpretation, being based upon the EuroLineScan program.

Quality-of-life concordance between patients with malignant gliomas (MG) and their caregivers.

2041 Background: Quality of life (QOL) in patients with malignant gliomas (MG) is important. Patients often minimize many aspects of QOL; hence, caregiver input is valuable. The purpose of this study was to investigate QOL concordance between patient and caregiver, in order to identify relevant discrepancies. Methods: Patients with MG within 6 months of diagnosis or relapse were eligible for this study if they had an involved caregiver. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) was given to patients and caregivers at baseline and then on the day MRIs were done for tumor assessment and continued until tumor progression. Patients were asked to fill out the FACT-Br and their caregiver was asked to fill out the same questionnaire as they perceived the patient would respond. MRI was done approximately every 2 months and questionnaires were given prior to disclosure of MRI results. Results: 51 pairs of FACT-Br scales were collected over the course of the study from 19 patient- caregiver pairs. A consistent discrepancy between patient and caregiver was seen. Patients reported their overall QOL to be better than perceived by their caregivers by an average of 9.9 points on the 200 point scale (p = 0.004). This difference was observed similarly for patients with newly diagnosed and recurrent MG and their caregivers. Significant differences were found within subscales of physical (p = 0.02), emotional (p = 0.01), and functional (p = 0.02) well-being, as well as brain cancer-specific items (p = 0.03). Social well-being was the only subscale where a significant discrepancy was not noted. The average score for the FACT-General was 76.1 in this sample of MG patients, significantly lower than the national average of 80.1 across all cancers. Conclusions: Results indicate patients consistently report their QOL to be more favorable than perceived by their caregivers. This finding underscores the importance of including caregivers in clinical assessments to obtain a comprehensive view of patient QOL and functional status. Physician-caregiver communication is essential to ensure quality care for patients with MG. No significant financial relationships to disclose.

Clinical performance of a transmission detector array for the permanent supervision of IMRT deliveries

Background and purpose Clinical evaluation of a novel dosimetric accessory serving the permanent supervision of MLC function. Materials and methods The DAVID system (PTW-Freiburg, Germany) is a transparent, multi-wire transmission ionization chamber, placed in the accessory holder of the treatment head. Since each of the 37 individual wires is positioned exactly below the associated leaf pair of the MLC, its signal records the opening of this leaf pair during patient treatment. Results The DAVID system closes a gap in the quality assurance program, permitting the permanent in-vivo verification of IMRT plans. During dosimetric plan verification with the 2D-ARRAY (PTW-Freiburg, Germany), reference values of the 37 DAVID signals are collected, with which the DAVID readings recorded during daily patient treatment are compared. This comparison is visually displayed in the control room, and warning and alarm levels of any discrepancies can be defined. The properties of the DAVID system as a transmission device, its sensitivity to beam delivery and leaflet errors as well as its stability have been analyzed for clinically relevant examples. In a recent version, the DAVID system has been equipped with 80 wires. Conclusions The DAVID system permits the on-line detection of clinically relevant MLC discrepancies in IMRT deliveries.

SU‐FF‐T‐482: Extension of An Informatics Architecture to Compare and Analyze 3D Dosimetric Data

Purpose: Novel 3D dosimetry techniques illustrate the urgent clinical need for tools for the comparison and visualization of dose data from various dosimeters. We present results from a collaborative effort to develop clinically useful methods to view, compare, and analyze dose data from a variety of dosimeters. Method and Materials: The development of a high‐resolution 3D dosimetry system (PRESAGE™ and optical‐CT) has motivated the re‐tooling of a previously existing informatics system — the Computational Environment for Radiotherapy Research (CERR) — to enable it to compare 3D dose data. Three different types of clinical dose distributions measured/calculated in PRESAGE dosimeters, EBT Gaf‐Chromic films and the Eclipse Treatment Planning System were used in this investigation. An intuitive and clinically relevant process for the comparison of these dose distributions has been developed. All volumetric (PRESAGE and Eclipse) and planar (EBT film) dose data was linked to the DICOM data and metadata of the irradiation. This allowed all doses to be registered to the relevant CT scan and viewed in 3D in standard, easily navigable, anatomic orientations. Results: Gamma analyses, line profiles, and dose‐difference plots were generated using the CERR platform. Relevant discrepancies amongst measured and calculated doses from different dosimeters were assessed and addressed from a single open‐source software platform. Conclusions: A comprehensive and flexible tool for 3D dosimetry, plan specific QA, and research is needed. CERR, with appropriate extensions, was found to be valuable as a tool for the comparison of doses measured using various techniques. Newer developments being implemented involve the integration of more advanced film calibration functionality, the ability to calculate 3D gamma volumes, and the ability to produce a dosimetry report including relevant information for patient specific plan evaluation.

Two-temperature thermodynamic and transport properties of argon–hydrogen and nitrogen–hydrogen plasmas

Two-temperature thermodynamic and transport properties of argon–hydrogen and nitrogen–hydrogen plasma mixtures are presented, chemical equilibrium being achieved. The calculations of transport properties are carried out using the Chapman–Enskog method up to the third order; when electron temperature differs from that of heavy particles, calculations are performed following both a recent two-temperature theory by Rat et al that retains the coupling between electrons and heavy particles and a simplified decoupling theory proposed by Devoto. No relevant discrepancies between results obtained using these two approaches have been found, allowing the simplified method of Devoto to be still used in the computation of non-equilibrium transport properties like thermal conductivity, electrical conductivity and viscosity, with the exception of some diffusion coefficients. Results for composition, mass density, specific heat, thermal conductivity, electrical conductivity and viscosity of atmospheric pressure plasmas in the electron temperature range 300–40 000 K are reported.

Postprocedural interpretation of endoscopic retrograde cholangiopancreatography by radiology.

With the increase in the use of endoscopic retrograde cholangiopancreatography (ERCP) (necessitating real-time interpretation), it is unknown whether post-ERCP radiologist reporting is still necessary or helpful. To determine the rate of discrepancy of results, and the rate of clinically relevant misses and additions, by the radiology report in a blinded setting. A retrospective analysis of the procedure and blinded postprocedure radiology reports of 100 consecutive ERCP cases was performed. A list of clinically relevant pathology and subgroups was made a priori. Discrepancies are described as proportions, with 95% CIs. The radiology yield regarding pathology that was clearly demonstrated at ERCP (bile leaks and stones removed) was calculated. Clinical follow-up was used to clarify additional abnormalities reported by radiology. Clinically relevant discrepancies in report pairs occurred in 29.0% of cases (95% CI 20% to 39%), or 40.0% if discrepancies regarding bile duct dilation are considered (95% CI 30% to 50%). In 15 of 30 cases (50.0% [95% CI 31% to 69%]) in which bile duct stones were removed, the radiologist did not report a stone. The radiologist did not report five of eight bile leaks (62.5% [95% CI 24% to 91%]). In seven cases (7.0% [95% CI 2.9% to 13.9%]), an additional abnormality was noted by radiology, including a biliary stricture, bile duct and pancreatic duct stones, as well as sclerosing cholangitis. However, during a mean follow-up period of 5.6 months, it appeared that these radiology interpretations were likely incorrect. Discrepancy rates did not vary among the ERCP attendings or by radiology volume. Discrepancies between endoscopists' and radiologists' ERCP reports are common. Blinded radiology interpretation frequently misses important pathology, and falsely positive additional diagnoses may be made.

Exercise calorimetry in sedentary patients: procedures based on short 3 min steps underestimate carbohydrate oxidation and overestimate lipid oxidation

Objectives Among exercise calorimetry tests designed for calculating the respective part of carbohydrates and lipids oxidized at exercise, some use 6 min steps and others use 3 min steps. Is this last method, which has been validated in healthy subjects, still accurate in very sedentary patients, who need more time to reach a steady state in respiratory gas exchanges? Methods We compared data obtained with calorimetry (RER and indicators of substrate oxidation) performed on the 2nd–3rd min and the 5th–6th min of each step of a protocol using four 6-min submaximal steps in 17 sedentary subjects (mean age: 51 years) including seven type 2 diabetics and six obese persons. Results Respiratory exchange ratio (RER) measured with the 3 min steps procedure are well correlated with the 6 min procedure in sedentary patients ( r = 0.928). However, a Bland–Altman analysis indicated an average underestimation of RER with 3 min steps (–0.0138). Moreover, we observed an average underestimation of carbohydrate oxidation rates of 70.1 mg/min with the 3 min steps procedure. On the contrary, as to lipid oxidation, we measured an average overestimation of 16.2 mg/min. Furthermore, carbohydrate and lipid oxidation rates measured with the 3 min steps procedure are well correlated with the 6 min steps procedure. Moreover, there was an average overestimation of the point at cross over with 3 min steps (+3.29 Watts). For lipox max point (power at which the increase in lipid oxidation induced by the increasing workload reaches a maximum), we observed an average underestimation with 3 min steps (–1.88 Watt). Although the differences between respectively mean values in cross over point and lipox max point between the two protocols are weak, a Bland–Altman analysis indicated more relevant discrepancies in many subjects between the two protocols. Conclusion In very sedentary patients undergoing such tests for targeting exercise prescription, the 3-min procedure appears to be too short for performing an accurate calorimetry and we rather recommend the protocol using 6-min steps.

Replacing Pretreatment Verification With In Vivo EPID Dosimetry for Prostate IMRT

To investigate the feasibility of replacing pretreatment verification with in vivo electronic portal imaging device (EPID) dosimetry for prostate intensity-modulated radiotherapy (IMRT). Dose distributions were reconstructed from EPID images, inside a phantom (pretreatment) or the patient (five fractions in vivo) for 75 IMRT prostate plans. Planned and EPID dose values were compared at the isocenter and in two dimensions using the gamma index (3%/3 mm). The number of measured in vivo fractions required to achieve similar levels of agreement with the plan as pretreatment verification was determined. The time required to perform both methods was compared. Planned and EPID isocenter dose values agreed, on average, within +/-1% (1 SD) of the total plan for both pretreatment and in vivo verification. For two-dimensional field-by-field verification, an alert was raised for 10 pretreatment checks with clear but clinically irrelevant discrepancies. Multiple in vivo fractions were combined by assessing gamma images consisting of median, minimum and low (intermediate) pixel values of one to five fractions. The "low" gamma values of three fractions rendered similar results as pretreatment verification. Additional time for verification was approximately 2.5 h per plan for pretreatment verification, and 15 min +/- 10 min/fraction using in vivo dosimetry. In vivo EPID dosimetry is a viable alternative to pretreatment verification for prostate IMRT. For our patients, combining information from three fractions in vivo is the best way to distinguish systematic errors from non-clinically relevant discrepancies, save hours of quality assurance time per patient plan, and enable verification of the actual patient treatment.

Parent and health professional perspectives in the management of adolescents with diabetes: Development of assessment instruments for international studies

Assessment of quality of life (QOL) in adolescents with diabetes requires patient, parent and health professional input. Psychometrically robust instruments to assess parent and professional perspectives are required. Questionnaires concerning adolescent QOL were developed for completion by parents and health professionals. In an international study assessing QOL in 2,101 adolescents with diabetes (median age 14 years, range 10-18; from 17 countries including Europe, Japan and North America), parents and health professionals completed their respective questionnaires between March and August 1998. Feasibility and acceptability of the new questionnaires were indicated by high questionnaire completion rates (adolescents 92%; parents 89%; health professionals 94%). Internal consistency was confirmed (Cronbach's alpha coefficients 0.80 parent; 0.86 health professional). Correlations of Diabetes Quality of Life Questionnaire for Youths (DQOLY) scores with parent and health professional global QOL ratings were generally low (r ranging from 0.12 to 0.36). Parent-rated burden decreased incrementally across adolescence, particularly for girls. Professional-rated burden followed a similar profile but only after age 15 years. Until then, burden was rated as uniformly high. Clinically relevant discrepancies in parent and professional burden scores were noted for one-parent families and families where adolescents had been referred for psychological help. In both cases, health professionals but not one-parent families perceived these as high burden situations. The clinical significance of this relates to the significantly poorer metabolic control recorded for adolescents in both situations. Parent and health professional questionnaires were found to have adequate internal consistency, and convergent and discriminant validity in relation to key clinical and QOL outcomes. The questionnaires are brief, easy to administer and score. They may also enable comparisons across countries and languages to facilitate development of international health outcome parameters. The inclusion of the parent and health professional perspectives completes a comprehensive assessment of adolescent QOL relevant to diabetes.