Therapy Center Research Articles

A comparison of carbon ions versus protons for integrated mode ion imaging.

Incorporating image guidance into ion beam therapy is critical for minimizing beam range uncertainties and realizing the modality's potential. One promising avenue for image guidance is to capture transmission ion radiographs (iRads) before and/or during treatment. iRad image quality is typically maximized using a single-event imaging system, which involves tracking individual ions, albeit the approach is generally not suited to clinical beam settings. An alternative faster and clinically compatible method is integrated mode imaging, where individual pencil beam data is acquired, rather than single ion data. To evaluate the usefulness of transmission ion imaging for image guidance, it is crucial to evaluate the image quality of integrated mode iRad systems. We report extensive image quality metrics of integrated mode carbon ion radiographs (cRads) and compare them with proton radiographs (pRads). iRads were obtained at the Marburg Ion Beam Therapy Center using a plastic volumetric scintillator equipped with CCD cameras. The detector captures orthogonal views of the 3D energy deposition in the scintillator from individual pencil beams. Four phantoms were scanned using a field of view and a beam spacing of 1 mm. First, 9 tissue-substitute inserts were used to evaluate water equivalent thickness (WET) accuracy. Radiographs of those inserts were reconstructed for beam spacings ranging from 1 to 7 mm to evaluate the impact of spacing on quantitative accuracy. For spatial resolution, custom 3D printed line pair (lp) modules ranging from 0.5 to 10 lp/cm were scanned. To evaluate low contrast detectability, a custom 3D printed low contrast module consisting of 20 holes with depths ranging from 1 to 8 mm and diameters from 1 to 10 mm was scanned. iRads of an anthropomorphic head phantom were alsoobtained. Spatial resolution and low contrast detection are systematically improved for cRads compared to pRads. Image resolution was 3.7 lp/cm for cRads and 1.7 lp/cm for pRads in the center of the field of view. Spatial resolution was found to vary with the object's location in the field of view. While pRads could mostly resolve low contrast holes of 10 mm in diameter, cRads could resolve holes of up in 4 mm diameter. WET accuracy is similar for both ion species, with a root mean squared error of approximately 1 mm. WET accuracy was stable (maximum of 0.1 mm increase) across beam spacings, although important under-sampling artifacts were observed for iRads reconstructed using large beam spacings, especially for cRads. iRads of the anthropomorphic head phantom showed improved apparent contrast using cRads, especially to identify bonystructures. This work is the first investigation of image quality metrics such as spatial resolution and low contrast detectability for integrated mode cRads, with a full comparison with pRads. Enhanced image quality is obtained with cRads compared to pRads, although pRads still maintain high WET accuracy and deliver image quality within acceptablebounds.

Real-world outcomes of Voretigene Neparvovec: a single-centre consecutive case series.

To present functional and anatomical outcomes of subretinal therapy with Voretigene Neparvovec (VN) in patients treated in one of the four specialist UK gene therapy centres. Single-centre, retrospective case series of patients affected by an inherited retinal dystrophy (IRD) caused by a pathogenic biallelic RPE65 mutation and treated with VN. Complete ophthalmic examination was planned preoperatively and 2, 4 and 8 weeks and 3, 6, 12, 18 and 24 months after surgery, and included visual acuity (VA) assessment (normal and low luminance), colour vision, contrast sensitivity, dark-adapted full-field stimulus threshold, macular optical coherence tomography (OCT) and fundus autofluorescence. Fourteen eyes of 8 patients were included with a mean follow-up of 26 months. Mean final VA improved by 2 lines, and improvements were noted in most other functional tests. Central retina thickness (CRT) remained fairly stable in the majority of patients, whereas 2 eyes experienced a reduction >30 μm. The status of ellipsoid band and external limiting membrane remained stable in all patients, except one. Peripapillary atrophy (PPA) was present in 5 eyes of 3 patients at the baseline; postoperative progression was noted in both eyes of one patient. No patient developed new PPA or chorioretinal atrophy (CRA) involving the macular area after treatment. Five eyes of 3 patients developed CRA at the retinotomy site, that progressed in 3 of them. Our study confirmed the effectiveness of subretinal VN therapy in terms of improvement of visual function. CRA was confirmed as a common postoperative complication, with limited functional impact.

Characterisation of the HollandPTC R&D proton beamline for physics and radiobiology studies.

HollandPTC is an independent outpatient center for proton therapy, scientific research, and education. Patients with different types of cancer are treated with Intensity Modulated Proton Therapy (IMPT). Additionally, the HollandPTC R&D consortium conducts scientific research into the added value and improvements of proton therapy. To this end, HollandPTC created clinical and pre-clinical research facilities including a versatile R&D proton beamline for various types of biologically and technologically oriented research. In this work, we present the characterization of the R&D proton beamline of HollandPTC. Its pencil beam mimics the one used for clinical IMPT, with energy ranging from 70 up to 240MeV, which has been characterized in terms of shape, size, and intensity. For experiments that need a uniform field in depth and lateral directions, a dual ring passive scattering system has been designed, built, and characterized. With this system, field sizes between 2×2cm2 and 20×20cm2 with 98% uniformity are produced with dose rates ranging from 0.5Gy/min up to 9Gy/min. The unique and customized support of the dual ring system allows switching between a pencil beam and a large field in a very simple and fast way, making the HollandPTC R&D proton beam able to support a wide range of different applications.

Genetic mutations and cytotoxic chemotherapy response for advanced solid tumors: A detailed analysis using the C-CAT database in Japan.

130 Background: Chemotherapy regimens are selected based on information about the primary organ or its histological type and are administered based on the results of previous clinical trials. Even now, as cancer genomic research has progressed and precision medicine, which optimizes therapeutic interventions based on tumor genome profiling using next-generation sequencing(NGS), has become standard treatment, cytotoxic anticancer drugs still remain key drugs. We examined the real-world database of genomic and clinical information established by the national central datacenter, the Center for Cancer Genomics and Advanced Therapy (C-CAT) to systematically analyze the effects of mutations across multiple cancers and therapies. Methods: This study delineated the association between genetic mutations and the therapeutic efficacy of cytotoxic chemotherapy in advanced solid tumors in a real-world Japanese clinical context. We incorporated data from 15,474 patients enrolled in the C-CAT database between June 2019 and June 2022. We analyzed the overall response and time to next treatment (TNT) for genetic alterations and five categories of cytotoxic anticancer drugs in gastrointestinal cancers. Results: In the C-CAT data, gastrointestinal cancers were frequently registered, with colorectal cancer being the most common, followed by pancreatic cancer, esophageal/gastric cancer, and biliary tract cancer. For platinum-based drugs, in colorectal cancer, the presence of gene X was associated with not only a higher response rate but also a longer TNT (hazard ratio 0.82, p<0.001). In the case of colorectal cancer and pancreatic cancer with KRAS gene mutations, the ORR was low, and the TNT was also short in the case of pancreatic cancer (hazard ratio 1.33, p<0.001). Interestingly, when BRCA2 genes are mutant, TNT tended to be longer in many organs, suggesting that platinum-based drugs are effective across organs in carcinomas with BRCA2 mutations. Additionally, gene X showed differences in efficacy not only for platinum but also for antimetabolites and topoisomerase inhibitors. Moreover, KRAS mutation was observed in almost all pancreatic cancers and was a treatment-resistant mechanism for all platinum drugs and antimetabolites. Conclusions: This study demonstrated that the effects of cytotoxic anticancer drugs differ depending on genetic mutations. When determining chemotherapy regimens, considering not only the organ but also genetic mutations may enable more efficient drug selection.

P-1450. Impact of Multi-morbidities on Quality of Life Among People Living with HIV at a tertiary care center in India: A cross-sectional study

Abstract Background India is home to an estimated 2.4 million People Living with HIV (PLHIV). The term "multi-morbidity" refers to the simultaneous presence of 2 or more chronic medical conditions in an individual, the prevalence of which is rising. The aim of our study is to assess the impact of multi-morbidities on Quality of Life (QoL) in PLHIV attending the Antiretroviral Therapy (ART) center at a tertiary care hospital in Western Maharashtra, India. Methods This was a cross-sectional study, over 2 months with 285 patients recruited. After ethical clearance was obtained, patients were interviewed to gather comprehensive sociodemographic history, with information on treatment and comorbidities obtained from patient charts. The QoL was measured using the WHOQOL-HIV BREF questionnaire which evaluates QoL across six domains: Physical, Psychological, Independence, Social, Environment, and Spiritual. Results The cohort exhibited an average of 2.2 comorbidities (SD = 1.4), with a notable prevalence of cardiovascular diseases and diabetes. Participants with 3 or more comorbidities demonstrated significantly lower QoL scores in the Physical (mean = 10.4, SD = 1.8, p < 0.01) and Psychological (mean = 11.9, SD = 1.5, p < 0.05) domains compared to those with fewer comorbidities. A longer duration of ART correlated positively with higher scores in the Independence domain (r = 0.26, p < 0.05). Elevated CD4 counts were linked with improvements in the Environmental and Psychological health domains. (p < 0.05) Participants from higher socioeconomic backgrounds reported significantly better scores in the Environmental and Spiritual domains (p < 0.05). Younger patients (< 40 years) reported better Social and Spiritual QoL scores compared to older individuals Gender-specific analysis indicated that females reported higher scores in the Social and Environmental domains. (p < 0.01). Conclusion There is a pressing need for effective management strategies that encompass comprehensive care approaches to address the complex health needs of this population. Enhancing routine screening for comorbidities and educating patients about the implications of multi-morbidities can empower PLHIV to improve QoL. Disclosures All Authors: No reported disclosures

Therapeutic rehabilitation for Klippel-Feil syndrome: a case report

Klippel-Feil syndrome (KFS) is a genetic condition presenting with a triad of symptoms: short neck, limited range of motion in the neck, and a low posterior hair line. Herein, we report the case of an eight-year-old girl who presented with complaints of pain, numbness, and a triad of KFS at the Paediatric Physical Therapy and Neuro-Rehabilitation Centre, Lahore. The aim of this report is to show that a rare syndrome can be coped very effectively through efficient goal setting. Physiotherapy intervention protocol was designed and given to the patient for four weeks and prognosis was established. Keywords: Klippel-Feil syndrome, Physiotherapy Intervention, Genetic Condition.

Abstract A003: Influence of beam pauses, dose, and dose rate on the FLASH effect in two mouse models

Abstract Limited understanding of the FLASH effect poses a challenge in gauging the feasibility of translation to clinical practice with the available radiotherapy equipment. We aimed to examine the effect of pausing during treatment, whether due to multi-field treatments or technical difficulties, and if there is a minimum dose or dose rate threshold for FLASH. Experiments were conducted on two distinct beamlines with associated beam properties: (i)a preclinical beamline at University of Washington Medical Center (UWMC) delivering a 50 MeV proton beam in scattering mode, and (ii)a clinical beamline at Fred Hutchinson Proton Therapy Center (PTC), delivering 229 MeV protons with pencil beam scanning (PBS). After dose finding experiments, we delivered a total 14-16 Gy to the pelvis of BALB/c mice or 6-8 Gy to the pelvis of SCID mice in transmission mode (∼45-120 Gy/s FLASH, 0.5-1 Gy/s CONV), using survival as endpoint. Utilizing both beamlines, we demonstrated a FLASH effect for delivery without pauses at or above 45 Gy/s, improving survival from 45% to 83%. The addition of a 30 second- or 2-minute pause in delivery, resulting in 2 doses of 7-8Gy delivered at 45Gy/sec or higher, resulted in a reduction of the FLASH effect, with an overall survival of 67% with either pause length. This led to question if the reduced effectiveness was due to the pause in treatment or reaching a minimum dose threshold. We then chose to examine FLASH with single 6-8Gy exposures in SCID mice as they have a much higher radiosensitivity and enable us to study the same endpoint at lower dose. Interestingly, in SCID mice we did not see a FLASH effect at all, with no significantly different survival either at 8Gy (78-80% survival) or 6Gy (12-15% survival) between FLASH and CONV arms. This loss of the FLASH effect could be explained by several factors; first, we may have hit the minimum dose threshold, second, SCID mice have impaired DNA damage repair (DDR), and third, SCID mice lack a fully functional immune system. To tease this apart we are currently performing experiments to deplete T-cell populations in BALB/c mice with anti-CD4/CD8 antibodies prior to irradiation to reduce immune system functionality but maintain DDR. Results are forthcoming. We observed the FLASH effect for both scattering and scanning proton beams when the dose was delivered in a single irradiation at ≥45 Gy/s. Including a pause of 30 seconds or 2 minutes seems to attenuate the FLASH effect but does not fully negate it. This attenuation may be due to the pause itself or the existence of a minimum dose threshold. Additionally, we have observed a loss of the FLASH effect in SCID mice, but the cause of this remains unknown and under investigation. At present we are working to decouple the potential effects of DDR and immune response in the FLASH effect in SCID mice. Citation Format: Danielle P. Johnson Erickson, Sunan Cui, Ning Cao, Matt Ruth, Alec Morimoto, Benjamin A Shaver, Zacharias Seitz, Clemens Grassberger, Jatinder Saini, Tony Wong, Eric Ford, Ramesh Rengan, Jing Zeng, Marco Schwarz. Influence of beam pauses, dose, and dose rate on the FLASH effect in two mouse models. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr A003.

Inclusive Education (Not) for All. Institutionalization of Social and Educational Problems of Children and Adolescents

Introduction: In recent years, inclusive education has become the main direction of education policy. It was intended to guarantee pupils with special educational needs, including maladjusted students and pupils at risk of social maladjustment, the opportunity to function fully in a school community, reducing the use of segregation-based and special solutions. Research Aim: The aim of the study was to determine whether implementation of inclusive education actually contributes to the integration of maladjusted students and those at risk of social maladjustment into mainstream education. Process tracking method was used in the analysis. Evidence-based Facts: Despite the demographic decline and a decrease in the total number of pupils with special educational needs statement, there was an increase in the number of children and adolescents placed in social rehabilitation and social therapy centres. Summary: The hypothesis that these changes are the result of the implementation of inclusive education was not supported. At the same time, the rival hypothesis assuming that the changes are the result of the progressive medicalisation of social problems and school failure, which promotes the use of special solutions, was not refuted.

Gadolinium oxide nanoparticles as a multimodal contrast enhancement agent for pre-clinical proton imaging

Orthotopic tumor models in pre-clinical translational research are becoming increasingly popular, raising the demands on accurate tumor localization prior to irradiation. This task remains challenging both in x-ray and proton computed tomography (xCT and pCT, respectively), due to the limited contrast of tumor tissue compared to the surrounding tissue. We investigate the feasibility of gadolinium oxide nanoparticles as a multimodal contrast enhancement agent for both imaging modalities. We performed proton radiographies at the experimental room of the Trento Proton Therapy Center using a MiniPIX-Timepix detector and dispersions of gadolinium oxide nanoparticles in sunflower oil with mass fractions up to 8wt%. To determine the minimum nanoparticle concentration required for the detectability of small structures, pCT images of a cylindrical water phantom with cavities of varying gadolinium oxide concentration were simulated using a dedicated FLUKA Monte Carlo framework. These findings are complemented by simulating pCT at dose levels from 80 mGy to 320 mGy of artificially modified murine xCT data, mimicking different levels of gadolinium oxide accumulation inside a fictitious tumor volume. To compare the results obtained for proton imaging to x-ray imaging, cone-beam CT images of a cylindrical PMMA phantom with cavities of dispersions of oil and gadolinium oxide nanoparticles with mass fractions up to 8wt% were acquired at a commercial pre-clinical irradiation setup. For proton radiography, considerable contrast enhancement was found for a mass fraction of 4wt%. Slightly lower values were found for the simulated pCT images at imaging doses below 200 mGy. In contrast, full detectability of small gadolinium oxide loaded structures in xCT at comparable imaging dose is already achieved for 0.5wt%. Achieving such concentrations required for pCT imaging inside a tumor volume inin-vivoexperiments may be challenging, yet it might be feasible using different targeting and/or injection strategies.

Utilization of healthcare services by young adults with first psychotic episodes at the FRITZ am Urban in Berlin considering the migration background

In Germany, there are hardly any studies that investigated the care pathways in the early course of psychosis and the duration of untreated psychosis (DUP) and took the migration background into account. The study examined whether young adults with (PwM) and without amigration background (PoM) who had afirst psychotic episode or first contact with the psychiatric care system within the last 5years differ in their utilization of care services and DUP. The data collection and post hoc analyses were carried out as apart of acohort study (84inpatients) at the Early Intervention and Therapy Center (FRITZ) in Berlin. The number of PwM (n = 38) who experienced afirst psychotic episode did not significantly differ from the comparison group (PoM, n = 46) in the utilization of healthcare services (p = 0.22). Neither the time until seeking help from the first service nor the number of contacts with healthcare services and DUP significantly differed between PwM and Pom. The PwM were predominantly young adults with agood education background who grew up in Germany. Users sought help at FRITZ relatively quickly, independent of their migration background, which supports further implementation of specialized early detection and intervention services in Germany. The results could be attributed to the selection of the study population. Further studies are needed that address people with lower education and low language skills. The early detection programs and awareness campaigns should be adapted to this target group.

Feasibility and safety of Taipei Veterans General Hospital Heavy Ion Therapy Center: The first carbon-ion irradiation facility in Taiwan.

Unlike conventional photon radiotherapy, particle therapy has the advantage of dose distribution. Carbon-ion radiotherapy is also advantageous in terms of biological effectiveness and other radiobiological aspects. These benefits lead to a higher response probability for previously known radioresistant tumor types. Therefore, Taipei Veterans General Hospital, which is located in the northern district of Taipei, built the first carbon-ion irradiation facility in Taiwan. Taipei Veterans General Hospital completed a phase 1 trial to evaluate the safety of carbon-ion radiotherapy. Six patients (4 males and 2 females with prostate adenocarcinoma, sacral chordoma, hepatocellular carcinoma, lung adenocarcinoma, or parotid high-grade carcinoma) were enrolled in this study. The mean age of the patients was 62.7 years. The mean dose was 57.3 Gy(RBE) (fraction range, 4-16 Gy(RBE)). During this phase 1 trial, all patients were monitored for 3 months to evaluate acute toxicity and short-term outcomes after treatment with carbon irradiation. Only 2 patients experienced grade 2 toxicity, which resolved without medication 1 month after completing treatment. The tumor response demonstrated 1 complete response, 1 partial response, and 4 cases of stable disease. Carbon-ion radiotherapy was determined to be an effective and safe treatment.

Mobile health in communication disorders: willingness to use, attitude, advantages, and challenges from the perspective of patients

IntroductionCommunication disorders are one of the most common disorders that, if not treated in childhood, can cause many social, educational, and psychological problems in adulthood. One of the technologies that can be helpful in these disorders is mobile health (m-Health) technology. This study aims to examine the attitude and willingness to use this technology and compare the advantages and challenges of this technology and face-to-face treatment from the perspective of patients.MethodsThis descriptive study was conducted with a researcher-made questionnaire and investigated the willingness and attitude of patients with communication disorders to use mobile health technology. The face and content validity of the questionnaire were examined with the help of experts in speech therapy, health information management, and medical informatics. Chi-square, Fisher's exact test, and the Kruskal–Wallis test were used to analyze the relationship between variables. Also, the challenges and advantages of mobile health technology and face-to-face treatment were extracted from the patient's answers and presented in the form of main themes and sub-themes.ResultsOne hundred seventy patients participated in this study. The results of this study showed that 57 (33.5%) participants preferred face-to-face visits, 11 (6.5%) preferred m-Health, and 102 (60.0%) preferred the combination of mobile applications and the face-to-face visits method. The results showed a statistically significant relationship between "Residence (rural or urban)", "Having trouble traveling to speech therapy centers", and "Delaying treatment due to lack of access to speech therapists" with treatment methods (face-to-face, mobile health, face to face and mobile health). Accessibility and convenience, treatment efficacy and variety, patient empowerment and confidence, family involvement and support, cost and time efficiency, treatment adherence and completion, and comfort and lifestyle compatibility were six categories related to the advantages of mobile health technology from the point of view of patients with communication disorders. Also, technological challenges, effectiveness and quality concerns, patient experience and engagement, and trust and confidence issues were mobile health challenges from the patients' point of view.ConclusionThe results of this study showed that patients tend to use both face-to-face interactions and mobile health. Integrating both m-Health and traditional methods can optimize speech therapy outcomes. Addressing challenges such as inadequate technological infrastructure and data security is crucial for successful implementation.

The Contribution of Transpersonal Psychology to The Emotional, Mental, and Spiritual Well-Being of Individuals

This research explores the impact of transpersonal psychology on the emotional, mental, and spiritual well-being of individuals. The study aims to understand how mindfulness, meditation, and holotropic therapy contribute to holistic well-being. Using a qualitative phenomenological approach, the research involved 20 participants, 12 males and eight females, aged between 25 and 60 years, from various holotropic therapy centers, meditation communities, and mindfulness groups across different ethnicities in Indonesia, including Javanese, Sundanese, and Balinese. Key informants included experts in transpersonal psychology; supporting informants were individuals directly engaged in these practices. Data were collected through in-depth interviews and participatory observation, then analyzed using thematic analysis with NVivo software. The findings indicate that transpersonal psychology significantly enhances participants' overall well-being by providing tools for deeper self-exploration, trauma healing, and spiritual development. Practices like mindfulness and meditation fostered present-moment awareness and emotional balance, while holotropic therapy facilitated access to higher states of consciousness and emotional processing. Integrating these practices into daily life helped individuals maintain a connection with their transpersonal awareness, even amidst daily challenges. This study underscores the importance of a holistic approach in psychology that includes the spiritual dimension, offering insights into how transpersonal psychology can support comprehensive personal growth and well-being.

Analysis and Assessment of Uvular Sound Production in Arabic among Individuals with Speech Disorders

This study investigates the production and acoustic characteristics of uvular sounds among individuals with speech disorders in Saudi Arabia, aiming to uncover the underlying mechanisms contributing to speech production discrepancies. By analyzing features such as pitch, intensity, jitter, shimmer, voice onset time, and harmonic-to-noise ratio through the PRAAT software, this research offers a detailed exploration of the spectral properties of uvular sounds. Statistical analyses of recordings from 20 participants at a speech therapy center revealed consistent patterns of phonetic substitutions, deletions, insertions, and distortions. These findings deepen our understanding of speech production challenges and lay the groundwork for developing artificial intelligence-driven assistive technology that could transform speech therapy for individuals with speech impairments and improve communication abilities and quality of life for those affected by speech disorders.

Hyperbaric Medicine in Pediatrics - reality of a Portuguese reference center.

To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

Impact of Early versus Delayed Excision and Grafting on Wound Healing and Treatment in Burn Injuries: A Retrospective Study

Background: Injuries from burns have an important effect on public health, especially in low- and middle-income nations, resulting in substantial mortality, morbidity and economic loss. The timing of excision and grafting is a key aspect in patient outcomes especially when it involves hypertrophic formation of scars. Methods: This retrospective study, performed at a top burn therapy centre in Islamabad, Pakistan, investigated the medical histories of patients who had been treated for deep cutaneious or full thickness burns. Patients were separated into two groups based on when they received their surgical intervention: early excision and grafting (EEG) within a week after damage and delayed excision and grafting (DEG) after one week. The primary outcome studied was the frequency and seriousness of hypertrophic scar development, which was determined using a conventional scar evaluation scale. Results: The study examined 100 patients and found that those enrolled in the EEG group had considerably better outcomes in terms of hypertrophic scar formation, hospital stay duration, rates of infection, and overall treatment expenses compared to the DEG group. The study emphasized the significance of early surgical treatments in improving burn treatment outcomes and the need for dedicated burn care facilities. Conclusion: Early excision and grafting within one week of suffering a burn injury greatly minimize the risk and severity of hypertrophic scars, decrease stays in the hospital, and reduce the incidence of infection and treatment costs.

Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation.

Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65%), occupational therapists (1396/4208, 33%), and allied health assistants (96/4208, 2%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70%). Devices were typically used to target impairment and activity limitation-related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51%, vs outpatient services, 963/2335, 41%) (χ21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51%, vs all other conditions, between 24%-31%; χ25=16.8, P=.005). The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use.

Application of Autism-Friendly Concept in the Interior Design of Autism Self-Development and Therapy Center in Surakarta

The Autism Self-development and Therapy Center is a special service center for people with autism with the main focus on developing self-development and therapy activities as an intervention effort for people with autism. The comparison between the number of children with autism is not comparable with the availability of facilities. Judging from the environment and the physical aspect of the building, in terms of capacity, activity, and space requirements, many things need to be improved. One of the facilities that currently not available in Surakarta is a facility that accommodates self-development activities. In addition, there are still many facilities with uncomfortable building conditions, some interior elements, and even dangerous furniture which is unsafe for autistic children. The design solution can be performed by creating self-development and therapy facilities with an autism-friendly concept. The application of this autism-friendly concept is by adjusting the type, texture, and color of the material as well as furniture that suits the needs of autistic children by considering comfort, safety, and the presence of natural factors. Thus, the autism-friendly concept is currently the best solution to overcome problems in autism facilities in Surakarta. The design method used in this design is based on references by Ballast (1992), starting with the Programming, Data Analysis, Idea Development, and Design Method (Design Development) stages. Based on the design results from the discussion, it is hoped that the Autism Self-development and Therapy Center can be a solution to the problems of children with Autism disorders and provide positive output for each autistic child. Keywords: Autism, Autism Friendly, Autism Self-develoment and Therapy Center

Early Detection Model of Drug Abuse Relapse in the City of Padang

The past year prevalence rate was 1.80% or 180 out of 10,000 Indonesians aged 15-64 years or equivalent to approximately 3.4 million people. The survey also found that drug abuse has penetrated into the countryside with very prominent drug use at a very productive age (25-49 years) and the prevalence rate in the past year of use above 2.5%. The various impacts of drug use can be overcome by conducting a rehabilitation program. The process of drug rehabilitation is a process given to drug addicts so that their mental, physical and social conditions improve, the existence of rehabilitation is expected to be able to reduce the adverse effects on physical and mental conditions and can reduce dependence and relapse due to drug use, so as to reduce the number of drug abusers. In this post-rehabilitation stage, drug abusers are prone to relapse. The case of relapse in drug users is very high, found in more than 50% of addicts in the last decade. Based on research, relapse rates are known to reach approximately 80 percent within the first six months, and occur as much as approximately 50 percent within two years. However, the various definitions of relapse have led to different relapse rates in Indonesia. The Ministry of Health in 2018 claimed that the relapse rate in Indonesia reached 24.3% while the relapse rate according to BNN stated that before the implementation of rehabilitation, Indonesia's relapse rate reached 90%. Indonesia's relapse rate after the implementation of rehabilitation at the Lido Bogor rehabilitation and therapy center is around 7%. Methods: This study uses a qualitative design with a phenomenological approach and aims to determine the determinants of early detection of relapse in drug abusers in Padang city. The informants in this study are drug abuser clients who are undergoing rehabilitation, in the post-rehabilitation program, and who have completed the rehabilitation program at HB Saanin Mental Hospital Padang, West Sumatera BNNP Clinic, and Yayasan Karunia Insani in Padang City, with a total of 6 people. In addition, the respondent sample consisted of 30 drug abusers who were undergoing rehabilitation. The analysis included instrument validity and reliability tests, expert analysis, and diagnostic test analysis. Results: Respondents' ages varied from 18 to 46 years old Factors that encourage relapse are the influence of friends and invitations from friends who use drugs. In addition, the absence of work and family problems also encourage relapse, Family, friends and community support for resilience, Informants revealed that rehabilitation programs can help informants from the risk of relapse, Informants confirmed that relapse can occur in anyone even in people undergoing intensive treatment, comprehensive and sustainable lecture programs can prevent relapse, Stress, depression, and social pressure factors affect the risk of relapse, the first signs of relapse felt by informants are unstable emotions. The developed relapse early detection model has significant predictive ability with an AUC of 78% and can predict the incidence of relapse with an accuracy between 60.2% and 95.8%. The model shows a strong correlation with the SSRS and has a 10,200 times greater chance of detecting relapse cases than the SSRS. Conclusion: Informants define relapse as a situation where someone who has used drugs uses drugs again, Factors that encourage relapse are the influence of friends and invitations from friends who use drugs. In addition, the absence of work and family problems also encourage relapse, Family, friends and community support for resilience, Informants revealed that rehabilitation programs can help informants from the risk of relapse, Informants confirmed that relapse can occur in anyone even in people undergoing intensive treatment, comprehensive and sustainable lecture programs can prevent relapse events, Stress, depression, and social pressure factors affect the risk of relapse, the first signs of relapse felt by informants are unstable emotions.

Detection of an internal density change in an anthropomorphic head phantom via tracking of charged nuclear fragments in carbon-ion radiotherapy.

Carbon-ion radiotherapy provides steep dose gradients that allow the simultaneous application of high tumor doses as well as the sparing of healthy tissue and radio-sensitive organs. However, even small anatomical changes may have a severe impact on the dose distribution because of the finite range of ion beams. An in-vivo monitoring method based on secondary-ion emission could potentially provide feedback about the patient anatomy and thus the treatment quality. This work aims to prove that a clinically relevant anatomical change in an anthropomorphic head phantom may be detected via charged-fragment tracking during a treatment fraction. A clinically representative carbon-ion treatment plan was created for a skull-base tumor in an anthropomorphic head phantom. In order to imitate an inter-fractional anatomical change - for example, through tissue swelling or mucous accumulation - a piece of silicone was inserted into the nasopharynx. Fragment distributions with and without the silicone insert were subsequently acquired with a mini-tracker made of four hybrid silicon pixel detectors. Experimental irradiations were carried out at the Heidelberg Ion Beam Therapy Centre (HIT, Germany). FLUKA Monte Carlo simulations were performed to support the interpretation of the experimental results. It was found that the silicone causes a significant change in the fragment emission that was clearly distinguishable from statistical fluctuations and setup uncertainties. Two regions of fragment loss were observed upstream and downstream of the silicone with similar amplitude in both the measurement and the simulation. Monte Carlo simulations showed that the observed signature is a consequence of a complex interplay of fragment production, scattering, and absorption. Carbon-ion therapy monitoring with charged nuclear fragments was shown to be capable of detecting clinically relevant density changes in an anthropomorphic head phantom under realistic clinic-like conditions. The complexity of the observed signal requires the development of advanced analysis techniques and underscores the importance of Monte Carlo simulations. The findings have strong implications for the ongoing InViMo clinical trial at HIT, which investigates the feasibility of secondary-ion monitoring for skull-base cancerpatients.