Standard Plan Research Articles

Research progress on acupuncture therapy for spastic hemiplegia after ischemic stroke

Spastic hemiplegia is a common clinical condition in patients with ischemic stroke, which has a significant impact on their motor function and quality of life. A large number of clinical studies have shown that acupuncture has significant advantages in treating spastic hemiplegia after stroke, and it is worth further promoting and applying in clinical practice due to its simple operation, high safety, and mild side effects. The commonly used clinical methods for acupuncture therapy of spastic hemiplegia after ischemic stroke include filiform needle therapy, electroacupuncture therapy, fire needle therapy, warm needle therapy, and other different acupuncture methods and acupoint selection methods, which can promote the recovery of limb motor function in patients. However, there is currently no clear international standardized treatment plan for acupuncture therapy. In the future, we should strengthen the rigor of clinical practice and research, and strive to contribute to the improvement of the quality of life of stroke patients.

'One millimetre equals one degree' is a major source of inaccuracy in planning osteotomies around the knee for metaphyseal deformities compared to the digital planning.

The objective of this study was to compare the accuracy of virtually performed osteotomies around the knee. The comparison was made between the Miniaci method (method 1), considered the gold standard planning, with the widely held dogma that one degree of correction required equates to one millimetre of opening/closing (method 2). This retrospective cross-sectional study was conducted between December 2018 and September 2022 in patients aged at least 15 years with metaphyseal knee deformity. Osteotomy planning was performed in methods 1 and 2 utilising calibrated long-leg alignment X-rays in the frontal plane. In both methods, the desired correction was defined by the Fujisawa point. The error % in measurement (ratio method 1/method 2) and the difference in millimetres (method 1 - method 2) between the two methods were analysed. A total of 107 osteotomies with 27 (25.2%) distal femoral osteotomies, 54 (50.5%) proximal tibial osteotomies and 26 (24.3%) double-level osteotomies were performed virtually with a mean hip-knee-ankle angle of 176.4 ± 6.6. In distal femur osteotomy, the mean error % between methods 1 and 2 was 38.9 ± 16.7% and 22.4 ± 16.8% for the opening and closing groups, respectively. In proximal tibial osteotomies, the mean error % was 22.7 ± 15.6% and 9 ± 10.8% for the opening and closing groups, respectively. In double-level osteotomy, the mean error % of femur-based corrections was 34.9 ± 19% and 19.5 ± 21% for the opening and closing groups, respectively, and the mean error of the tibial-based corrections was 26.4 ± 12.1% for the opening group and 10.8 ± 10% for the closing group, respectively. Planning one millimeter per degree of desired correction for osteotomies around the knee in metaphyseal deformities is a major source of error when compared with digital planning using the Miniaci method. This was seen most frequently with osteotomies of the distal femur and all opening wedge osteotomies. Level Ⅲ, retrospective cross-sectional study.

A Hybrid Type 1 trial of a multi-component mHealth intervention to improve post-hospital transitions of care for patients with serious mental illness: Study protocol

BackgroundThe transition from acute (e.g., psychiatric hospitalization) to outpatient care is associated with increased risk for rehospitalization, treatment disengagement, and suicide among people with serious mental illness (SMI). Mobile interventions (i.e., mHealth) have the potential to increase monitoring and improve coping post-acute care for this population. This protocol paper describes a Hybrid Type 1 effectiveness-implementation study, in which a randomized controlled trial will be conducted to determine the effectiveness of a multi-component mHealth intervention (tFOCUS) for improving outcomes for adults with SMI transitioning from acute to outpatient care. MethodsAdults meeting criteria for schizophrenia-spectrum or major mood disorders (n = 180) will be recruited from a psychiatric hospital and randomized to treatment-as-usual (TAU) plus standard discharge planning and aftercare (CHECK-IN) or TAU plus tFOCUS. tFOCUS is a 12-week intervention, consisting of: (a) a patient-facing mHealth smartphone app with daily self-assessment prompts and targeted coping strategies; (b) a clinician-facing web dashboard; and, (c) mHealth aftercare advisors, who will conduct brief post-hospital clinical calls with patients (e.g., safety concerns, treatment engagement) and encourage app use. Follow-ups will be conducted at 6-, 12-, and 24-weeks post-discharge to assess primary and secondary outcomes, as well as target mechanisms. We also will assess barriers and facilitators to future implementation of tFOCUS via qualitative interviews of stakeholders and input from a Community Advisory Board throughout the project. ConclusionsInformation gathered during this project, in combination with successful study outcomes, will inform a potential tFOCUS intervention scale-up across a range of psychiatric hospitals and healthcare systems.Clinicaltrials.govregistration: NCT05703412

Trauma Patient-Centered Discharge Plan Form: A Pilot Study.

Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge. This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients. A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported. The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients). The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.

Phase 1 trial of same day cytology to guide the use of HIPEC.

Peritoneal metastases from gastrointestinal or gynecologic malignancy are a prominent part of the natural history of these diseases. Peritoneal metastases, if not effectively treated, will result in a decreased survival and cause an impaired quality of life. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment specifically designed to combat peritoneal metastases. A group of patients who, from a theoretical perspective, may benefit from HIPEC are those patients with a positive peritoneal cytology. In order to identify these patients at the time of a surgical intervention, a same day cytology is to be performed. The result of this test is to be available at or before the completion of the cancer resection. If the cytology is positive, the patient immediately becomes a candidate for HIPEC. The HIPEC will be of maximal value if a complete cytoreduction, as judged by the surgeon, has been possible. This phase 1 trial is to demonstrate that the Surgical Oncology Service, the Department of Pathology, the Pharmacy and the Operating Room personnel can co-ordinate a phase 1 protocol to successfully complete the same day cytology with an efficient delivery of HIPEC. A standardized plan for consent, cytology collection, preparation of the specimen, reading of the specimen, reporting the results in a timely manner facilitates the administration of HIPEC in peritoneal cytology positive patients. Successful completion of these requirements is a positive result for this study and allows for future protocols to be generated. Successful completion of the same day cytology phase 1 protocol will allow the efficacy, safety, and efficiency of this plan of patient management to be evaluated.

Exploration and Practice of Big Data Introductory Courses for Big Data Management and Application Majors

As an introductory course for the emerging major of big data management and application, “Introduction to Big Data” has not yet formed a curriculum standard and implementation plan that is widely accepted and used by everyone. To this end, we discuss some of our explorations and attempts in the construction and teaching process of big data courses for the major of big data management and application from the perspective of course planning, course implementation, and course summary. After interviews with students and feedback from questionnaires, students are highly satisfied with some of the teaching measures and programs currently adopted.

Study On The Improvement Of Precise Transfer Process For Critically Ill Neonates

Objective To improve the nursing strategy of critically ill neonatal transport and provide guidance for neonatal transport nursing through the study of critically ill neonatal transport. Methods From January 2020 to July 2023, according to the specific requirements and management regulations of epidemic prevention and control, our hospital established a strict and standardized transport plan, carried out transport tasks for 472 newborns who met the transport indications, and organization and management in the transport process; full security protection policy ;the improvement of transport quality and psychological support of family members were studied and analyzed. Results All 472 neonates arrived at the transport hospital safely, their condition did not worsen, their vital signs were stable, and the accompanying medical personnel and drivers did not have infection symptoms. Conclusion This study concluded that in the process of critically ill neonatal transport, the corresponding quality improvement was made in all aspects, which significantly improved the safety of transport during the epidemic period, met the needs of primary hospitals, ensured the life treatment of critically ill children, and maintained the integrity of the medical system.

Hypoglycemia after Mitral Valve Repair in Dogs.

Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair (MVR) in dogs; however, the authors have encountered cases of hypoglycemia after MVR. This study aimed to determine the incidence of hypoglycemia in dogs after MVR and investigate its causes. Blood glucose levels were measured at multiple timepoints in dogs undergoing MVR. Simultaneously, insulin and glucagon blood concentrations in dogs with hypoglycemia preoperatively and postoperatively were compared to verify the physiological responses to hypoglycemia. Furthermore, risk factors for hypoglycemia, using variables selected based on the characteristics of MVR and dogs undergoing MVR, were examined prospectively. The incidence of hypoglycemia after MVR was 14.2%, and plasma glucagon concentrations increased in these dogs (mean: 260 pg/mL and 644 pg/mL pre- and postoperatively, p < 0.001), whereas serum insulin concentrations decreased (median: 0.50 ng/mL and 0.29 ng/mL pre- and postoperatively, p = 0.002). Therefore, hyperinsulinemia or hypoglucagonemia is unlikely to be the cause of postoperative hypoglycemia. The identified risk factors for hypoglycemia included low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after MVR should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs.

Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique.

One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n=13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening<24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA)<48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.

Dosimetric Comparison of Isodose Surface Volume and Total Reference Air Kerma (TRAK) based Volume in Cervical Cancer Brachytherapy.

We aim to compare TRAK & TPS based isodose volumes in cervical cancer brachytherapy and assess the feasibility, accuracy and potential future implications of TRAK in this regard and as a newer emerging tool to assess treatment intensity in cervical cancer brachytherapy. one hundred patients with histologically proven squamous cell carcinoma of cervix uteri were assessed for brachytherapy (after completion of external radiation) and prospectively enrolled for the study. 60 Gy, 75 Gy, and 85 Gy isodose volumes were obtained from the TPS (VTPS) for 50, 25 & 25 patients with Manchester, Fletcher & interstitial implant respectively, receiving various fractionation schedules by Ir192 HDR remote after-loading system. Using the formula Vpred=4965(TRAK/dref)3/2+170(TRAK/dref)-1.5 the TRAK based isodose surface volumes (Vpred) were derived. Reference doses (dref) were calculated based on accumulated EBRT and brachytherapy doses. The two sets of volume were compared with respect to applicator type, standard, and optimised plan. Surrogate point A dose was also correlated. VTPS - Vpred were 5.24 ± 2.7%, all volumes being predicted within 10%. Correlation of TRAK vs VTPS60/ VTPS75/ VTPS85 showed R2 of 0.994, 0.987 and 0.971 respectively. There was no significant difference in predicted volumes with respect to applicator type. The surrogate point A showed mean volume and standard deviation of 7.44 ± 13.4%, 17.63 ± 16.38 and 3.5 ± 0.95 for Manchester optimised, Fletcher optimised and standard plans respectively. TRAK with point A (R2=0.5632), bladder (R2=0.2015) and rectal doses (R2=0.121) yielded no correlation. Volumes calculated by TRAK correlate with TPS obtained volumes significantly and the formula predicting isodose surface volumes within 10% accuracy for ICBT applications and not for pure interstitial implants. However, TRAK fails to correlate with surrogate point A, bladder and rectal doses hence has questionable utility as a marker for biological response & treatment intensity.

Construction and validation of a novel web-based nomogram for primary ocular adnexal lymphoma: a real-world analysis based on the Surveillance, Epidemiology, and End Results database.

The occurrence rate of primary ocular adnexal lymphoma (POAL) is relatively low, and estimation of prognosis of these patients poses significant challenges. This study aims to investigate the independent prognostic factors of POAL patients and establish a predictive model to provide clinical data for the formulation of standardized treatment plans. We conducted a retrospective analysis by extracting data of POAL patients diagnosed between 2000 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. The enrolled patients were randomly divided into a training group and a testing group in a 7:3 ratio. To identify independent prognostic factors, we used both univariate and multivariate Cox regression analyses. Conditional survival (CS) pattern of these patients was analyzed. We formulated a nomogram model to forecast survival rates at intervals of 2, 5, 10, and 15 years. The reliability of the model's predictions was assessed through the concordance index (C-index) and the area under the receiver operating characteristic (ROC) curve (AUC). Moreover, we designed an online survival calculator using the nomogram model. The study ultimately analyzed 3,324 patients with POAL, of which 2,327 and 997 were respectively assigned to a training group and a testing group. Important prognostic factors including age, sex, tumor site, tumor histology, coexistence of other malignancy, surgery, radiotherapy (RT), and marital status were identified. Based on these predictors, a novel nomogram model was successfully developed with excellent predictive performance, which can also be accessed on the website: https://helloshinyweb.shinyapps.io/eye_dynamic_nomogram/. The calibration curves demonstrated good consistency between the predicted and actual survival rates. Additionally, the C-index and AUC demonstrated good discriminative ability. This study has successfully developed and validated a prognostic nomogram model that accurately predicts the survival rate of patients with POAL. The model proves invaluable in enabling clinical doctors to assess patients' risk factors and formulate personalized treatment strategies, thereby enhancing survival assessment and clinical management for POAL patients.

Analysis of respirable dust exposure data collected at a Zambian copper mine between 2017 and 2022.

Mine workers are occupationally exposed to respirable dust, which can cause irreversible lung diseases and controlling exposure concentrations to as low as reasonably practicable is, therefore, essential. To implement exposure reduction strategies and adequately manage exposure to hazardous chemicals, exposure needs to be measured and recorded according to a standard exposure management plan. This study aimed to assess the available respirable dust exposure data measured between 2017 and 2022 in various work areas and job categories at two mining shafts and a concentrator plant of a Zambian copper mine. Additionally, the monitoring program implemented at the mine was assessed for appropriateness. Descriptive data analysis was used to create an exposure matrix comprising 253 exposure measurements. Approximately 5.6% of the measured concentrations exceeded the South African time-weighted average occupational exposure limit (TWA-OEL) of 3 mg/m3. The geometric means of respirable dust exposure for shaft A, shaft B and the concentrator plant were 0.44 mg/m3, 0.44 mg/m3, and 0.68 mg/m3, respectively. The work areas with the highest maximum exposure results were the tipping area (18.0 mg/m3) at shaft A, the sump and waste bin (8.05 mg/m3) at shaft B and the screening (10.8 mg/m3), secondary crusher (14.0 mg/m3), foreign ore bin (4.43 mg/m3), and tertiary crusher (5.07 mg/m3) areas at the concentrator plant. It was found that the monitoring strategy implemented at the mine was flawed and did not collect a sufficient number of samples in each area during each year to make rigorous statistical assessment possible. This study highlights the sampling strategy's shortcomings and recommends adopting a standardized monitoring strategy, such as EN689, to improve the respirable dust monitoring program at the mine. Additionally, this strategy can be implemented across Zambia and, if implemented correctly, it has the potential to be improve exposure monitoring across the country as no standard sampling strategy is currently enforced by the Government.

The RADTRAD analysis methodology for the Fuel Handling Accident during the long-term shutdown period of Chinshan Nuclear Power Plant

Abstract This study presents a methodology for the Fuel Handling Accident (FHA) analysis during the long-term shutdown period with the fuels still residing in the reactor core for the Chinshan BWR/4 Nuclear Power Plant. This methodology can be used to calculate the radiation dose received by the control room personnel, assuming failure in safety systems, facilities or structures. The computer code RADTRAD is employed to perform the transport and release of radioactive inventories first, and then calculate the control room dose based on appropriate dose conversion factor for the FHA. The results show that even failure in safety systems, facilities or structures, the whole body dose, thyroid dose and beta-skin dose are well below the acceptance limits specified in the Standard Review Plan.

Expert consensus on the treatment of second-degree burn wounds (2024 edition)

Second-degree burn is the most common type of burns in clinical practice and hard to manage. The choice of its treatment requires not only consideration of the different outcomes that may arise from dressing changes or surgical treatments themselves, but also evaluation of factors such as burn site, ages of patients, and burn area. Meanwhile, there is no unified standard and specification for the diagnosis, classification, surgical procedure, and infection judgment and grading of second-degree burn wounds, which significantly affects the formulation of clinical treatment plans and the consistency of clinical studies. Moreover, there is relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guideline or expert consensus for the treatment of second-degree burn wounds. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds (2024 edition) based on evidence-based medicine evidence and expert opinion. This expert consensus put forward 58 specific recommendations from four aspects: pre-hospital first aid, non-surgical treatment, surgical treatment, and infection prevention and treatment of second-degree burns wounds, aiming to form a standardized clinical treatment plan for second-degree burns.

Spatial multi-criteria decision analysis for the selection of sentinel regions in tick-borne disease surveillance

BackgroundThe implementation of cost-effective surveillance systems is essential for tracking the emerging risk of tick-borne diseases. In Canada, where Lyme disease is a growing public health concern, a national sentinel surveillance network was designed to follow the epidemiological portrait of this tick-borne disease across the country. The surveillance network consists of sentinel regions, with active drag sampling carried out annually in all regions to assess the density of Ixodes spp. ticks and prevalence of various tick-borne pathogens in the tick population. The aim of the present study was to prioritize sentinel regions by integrating different spatial criteria relevant to the surveillance goals.MethodsWe used spatially-explicit multi-criteria decision analyses (MCDA) to map priority areas for surveillance across Canada, and to evaluate different scenarios using sensitivity analyses. Results were shared with stakeholders to support their decision making for the selection of priority areas to survey during active surveillance activities.ResultsWeights attributed to criteria by decision-makers were overall consistent. Sensitivity analyses showed that the population criterion had the most impact on rankings. Thirty-seven sentinel regions were identified across Canada using this systematic and transparent approach.ConclusionThis novel application of spatial MCDA to surveillance network design favors inclusivity of nationwide partners. We propose that such an approach can support the standardized planning of spatial design of sentinel surveillance not only for vector-borne disease BDs, but more broadly for infectious disease surveillance where spatial design is an important component.

Comparison of Three Dimensional Dental Software Computed Tomography Findings with Real Time Surgical Approaches for Impacted Teeth

An exact localization of impacted teeth is often difficult to assume by using two dimensional conventional radiological techniques like OPG or dental films. In contrast to these two dimensional imaging method, the Dental slice Software Computed Tomography offers a three-dimensional imaging of maxilla-facial region, providing the opportunity to study objectives in all standard plans with three-dimension, reconstructed and multisection views. The aim of this study is to prove the effectiveness of the Dental slice Software Computed Tomography in evaluating the position of impacted teeth as a presurgical diagnostic aid. 25 patients with total of 40 impacted teeth were classified and evaluated by three sets .The first set of radiographs consist of traditional two dimensional images(per apical , occlusal films and OPG).The second set comprised three-dimensional views obtained from a Dental slice Soft ware Computed Tomography and a third set which was surgical interventions results. Teeth crowns were classified into: type I (buccal or labial), type II (palatal or lingual), type III (half distance of the labio-palatal or bucco-palatal ,labio-lingual or bucco-lingual) according to their position within dental arches. The dental soft ware Computed Tomography succeeded to identify the exact situations of whole 40(100%) impacted teeth crowns that were confirmed surgically in the same anatomical locations. On the other hand there was a Failure of 33(82.5%) crowns that could not be determine their positions by two dimensional images and proved surgically in opposite sides. Three dimensional Computed Tomography is a helpful and stimulating tools by providing the surgeons a perfect mulitislices: axial, coronal, sagital, two dimensional and three dimensional images in one visit and once exposure and permits the oral surgeons to visualize the position and surgical anatomy of the tooth as it will be in the operating theatre, thus establishing sufficient patterns for adequate surgical planning ,reduce of need for exploratory procedures with less morbidity to the osseous structure and time saving.

Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical treatment

Second-degree burn is the most common type of burns in clinical practice and hard to manage. At present, there is no unified standard or specification for the first aid, diagnosis, classification, manner of conservative dressing change, and choice of external dressings or medications for second-degree burn wounds, which significantly affects the formulation of clinical treatment plans and the consistency of clinical studies. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical treatment based on evidence-based medicine evidence and expert opinion. This expert consensus put forward 29 specific recommendations from 2 aspects: pre-hospital first aid and non-surgical treatment for second-degree burn wounds, aiming to form a standardized clinical treatment plan for second-degree burn wounds.

Mortgages with non-random time-varying interest rates

AbstractHere we introduce an “alternative” version of the standard traditional amortization plan, where sequences of non-random time-varying periodic interest rates replace the usual constant periodic effective rate, while preserving all the other classical rules. In particular, we use two of these sequences coherently generated by two different specific hyperbolic instantaneous intensity functions. We found that the two standard amortization plans obtained through this approach match perfectly with the two main amortization plans recently proposed under the simple capitalization law. This matching provides thus a clear link between the traditional scheme and the new wave of proposals in simple regime.

Multibody dynamic modeling of the behavior of flexible instruments used in cervical cancer brachytherapy.

The steep radiation dose gradients in cervical cancer brachytherapy (BT) necessitate a thorough understanding of the behavior of afterloader source cables or needles in the curved channels of (patient-tailored) applicators. The purpose of this study is to develop and validate computer models to simulate: (1) BT source positions, and (2) insertion forces of needles in curved applicator channels. The methodology presented can be used to improve the knowledge of instrument behavior in current applicators and aid the development of novel (3D-printed) BT applicators. For the computer models, BT instruments were discretized in finite elements. Simulations were performed in SPACAR by formulating nodal contact force and motion input models and specifying the instruments' kinematic and dynamic properties. To evaluate the source cable model, simulated source paths in ring applicators were compared with manufacturer-measured source paths. The impact of discrepancies on the dosimetry was estimated for standard plans. To validate needle models, simulated needle insertion forces in curved channels with varying curvature, torsion, and clearance, were compared with force measurements in dedicated 3D-printed templates. Comparison of simulated with manufacturer-measured source positions showed 0.5-1.2mm median and<2.0mm maximum differences, in all but one applicator geometry. The resulting maximum relative dose differences at the lateral surface and at 5mm depth were 5.5% and 4.7%, respectively. Simulated insertion forces for BT needles in curved channels accurately resembled the forces experimentally obtained by including experimental uncertainties in the simulation. The models developed can accurately predict source positions and insertion forces in BT applicators. Insights from these models can aid novel applicator design with improved motion and force transmission of BT instruments, and contribute to the estimation of overall treatment precision. The methodology presented can be extended to study other applicator geometries, flexible instruments, and afterloading systems.

Input/output-style approach to standardized traditional amortization plans

AbstractWe apply an Input/Output approach to the analysis of the so-called traditional standardized amortization plans (STAP). The approach is based on a clear distinction between Input/trigger and Output of a STAP. The Output is a set of four vectors obtained by applying a set of transformation matrices to an appropriate Input/trigger vector. The main result of the paper is that, by this approach, any STAP reveals a dual nature through the introduction of the twin trigger theory.