Identification badge lanyards as infection control risk: a cross-sectional observation study with epidemiological analysis.

Staphylococcus aureus cultures from name badge lanyards were phenotypically and genotypically indistinguishable from the wearer's nasal carrier strains by pulsed-field gel electrophoresis and antibiogram. Lanyards had a mean age of 22 months and hygiene was poor with only 9% ever having been laundered. Molecular analysis showed that 26% of S. aureus nasal carriers shared an indistinguishable strain on their lanyard. Lanyards should not be recommended for staff in frontline clinical care.

Heightened condition-dependent growth of sexually selected weapons in the rhinoceros beetle, Trypoxylus dichotomus (Coleoptera: Scarabaeidae).

The exaggerated weapons and ornaments of sexual selection are condition-dependent traits that often grow to exaggerated proportions. The horns of male rhinoceros beetles are extremely sensitive to the larval nutritional environment and are used by rival males in combat over access to females. In contrast to horns, other parts of the body, such as wings, eyes, and legs, scale proportionally with body size, whereas others, such as males' external genitalia, are invariant with body size, regardless of nutrition. We document how body parts of the Asian rhinoceros beetle, Trypoxylus dichotomus, exhibit plasticity and constraint in response to nutritional condition. We discuss the implications of these results for the evolution of condition-dependent and condition-independent traits in animals.

Measurements of the proton elastic-form-factor ratio mu pG p E/G p M at low momentum transfer.

High-precision measurements of the proton elastic form-factor ratio, mu pG p E/G p M, have been made at four-momentum transfer, Q2, values between 0.2 and 0.5 GeV2. The new data, while consistent with previous results, clearly show a ratio less than unity and significant differences from the central values of several recent phenomenological fits. By combining the new form-factor ratio data with an existing cross-section measurement, one finds that in this Q2 range the deviation from unity is primarily due to G p E being smaller than expected.

Serum urea concentration as a predictor of dietary lysine requirement in selected lines of pigs.

Serum urea concentrations were measured in Large White pigs from lines divergently selected for components of efficient lean growth rate and performance tested over three 14-d test periods starting at 30, 50, and 75 kg. Two methods of performance testing were used. Phase-fed pigs were fed to appetite isoenergetic diets differing in total lysine:energy ratio (0.58, 0.69, 0.81, 0.91, 1.01, 1.12, and 1.23 g/MJ of digestible energy), whereas diet-choice pigs were offered a choice of the 0.69 and 1.12 lysine:energy diets. Between test periods, all animals were fed one diet: 0.91 g of lysine/MJ of digestible energy. The study consisted of 230 boars and gilts with 150 pigs performance tested on phase-feeding and 80 pigs on diet-choice. The line selected for high lean food conversion had lower urea concentrations on each diet than the line selected for high lean growth rate, despite similar predicted lysine balances. Efficiency of lean growth rather than the rate of lean growth may be a better selection strategy in the context of nitrogen excretion. Urea concentrations at the end of each test period were correlated with lysine intake (0.33, 0.48 and 0.65; standard error, 0.08) and predicted lysine balance (0.39,0.44, and 0.64), but were uncorrelated with predicted lysine for protein deposition (0.01, 0.08, and 0.08) and maintenance. Urea concentration at the end of a test period was not a useful predictor of protein deposition, even after accounting for pretest variation in urea concentration and food intake during test. The expected response pattern of serum urea concentration to diets differing in total lysine:energy would be nonlinear, with the point of inflection occurring at the required dietary total lysine:energy for each genotype. However, there was no evidence of such an inflection point such that the prediction of lysine requirement from urea concentration was not possible for the selection lines in the study.

Serum neuropeptide Y (NPY) and leptin concentrations in pigs selected for components of efficient lean growth.

Responses in log transformed serum neuropeptide Y (NPY) concentration and leptin concentration after six generations of divergent selection on components of efficient lean growth in pigs were measured. From an animal breeding perspective, serum NPY and/or leptin concentrations could be used as physiological predictors of genetic merit if there were significant responses to selection. At 90 kg liveweight, log transformed serum NPY concentrations were increased with divergent selection for low food conversion ratio (LFC) (6.31 versus 5.72, SED 0.09 log(pmol/L)) or for high lean growth rate (LGA) (5.80 versus 5.37 log(pmol/L)) but not with selection on daily food intake (DFI) (6.26 versus 6.14 log(pmol/L)). Selection for high DFI was associated with increased serum leptin concentration (3.06 versus 2.45, SED 0.21 ng/mL human equivalent (HE)) as was selection for low LFC (3.04 versus 2.46 ng/mL HE). Correlations between leptin and predicted lipid weight increased with stage of test (0.13, 0.34 and 0.43, SE 0.08 at 30, 50 and 75 kg). The high correlations between successive serum NPY concentrations (0.80, SE 0.11) suggest that changes in body composition with time would not be reflected in serum NPY concentrations. Serum NPY and, to a lesser extent, serum leptin concentrations were insensitive to dietary differences in total lysine: energy and indicated that studies using a genetic resource population of animals may be more powerful than nutritional studies using isoenergetic diets differing in lysine content to examine aspects of function of serum concentrations of NPY and leptin in pigs.

Decreasing the dosimetric effects of misalignment when using a mono-isocentric technique for irradiation of head and neck cancer.

PURPOSE: The purpose of this study was to quantify and develop methods to decrease inhomogeneities created with field edge mismatch when using a mono-isocentric beam-split technique. METHODS AND MATERIALS: We validated techniques to determine dose across a half-blocked field edge and quantified potential sources of systematic matchline error. Then, two methods were used to evaluate matchline doses. The first used film dosimetry data from a half-beam field and a spreadsheet. Duplication and reversal provided two columns, each representing a beam-split field edge. Summation simulated perfect abutment and shifting created various gaps and overlaps. The second method involved obtaining dose profiles at midfield along the ray perpendicular to abutted, overlapped, and gapped beam-split fields on six linear accelerators. To enlarge the penumbra, we designed several field edge modifiers, then re-evaluated matchline doses. The field edge modifiers applicability to a 3-field head and neck treatment technique was also examined. RESULTS: Film-determined dose profiles provide similar information across a beam-split field edge as an ionization chamber. With the mono-isocentric beam-split technique, a 4-mm overlap or gap produces inhomogeneities nearly 60% above or below the intended dose. A 2-mm overlap or gap produces inhomogeneities nearly 30% above or below the intended dose. A customized penumbra generator decreased the magnitude of these inhomogeneities to 20% and 10%, respectively. CONCLUSION: The two methods of evaluating matchline dose described above gave similar results. When using the mono-isocentric half-field technique, small misalignments produce worrisome regions of inhomogeneity. Our penumbra generator substantially decreases the magnitude of the dose inhomogeneities, although the volume receiving an inhomogeneous dose increases.

Modeling photon output caused by backscattered radiation into the monitor chamber from collimator jaws using a Monte Carlo technique.

Dose per monitor unit in photon fields generated by clinical linear accelerators can be affected by the backscattered radiation into the monitor chamber from collimator jaws. Thus, it is necessary to account for the backscattered radiation in computing monitor unit setting for a treatment field. In this work, we investigated effects of the backscatter from collimator jaws based on Monte Carlo simulations of a clinical linear accelerator. The backscattered radiation scored within the monitor chamber was identified as originating either from the upper jaws (Y jaws), or from the lower jaws (X jaws). From the results of Monte Carlo simulations, ratios of the monitor-chamber-scored dose caused by the backscatter to the dose caused by the forward radiation, R(x,y), were modeled as functions of the individual X and Y jaw positions. The amount of the backscattered radiation for any field setting was then computed as a compound contribution from both the X and Y jaws. The dose ratios of R(x,y) were then used to calculate the change in photon output caused by the backscatter, Scb(x,y). Results of these calculations were compared with available measured data based on counting the electron pulses or charge from the electron target of an accelerator. Data from this study showed that the backscattered radiation contributes approximately 3% to the monitor-chamber-scored dose. A majority of the backscattered radiation comes from the upper jaws, which are located closer to the monitor chamber. The amount of the backscatter decreases approximately in a linear fashion with the jaw opening. This results in about a 2% increase of photon output from a 10 cm x 10 cm field to a 40 cm x 40 cm field. The off-axis location of the jaw opening does not have a significant effect on the magnitude of the backscatter. The backscatter effect is significant for monitor chambers using kapton windows, particularly for treatment fields using moving jaws. Applying the backscatter correction improves the accuracy of monitor-unit calculation using a model-based dose calculation algorithm such as the convolution method.

Serum leptin concentration in pigs selected for high or low daily food intake.

Selection for high or low daily food intake (DFI) in Large White pigs resulted in higher serum leptin concentration, fat deposition and food intake in the high DFI line. The response in serum leptin concentration indicated that the higher fat deposition of the high DFI line was not due to insufficient leptin production, as in the Lepob/Lepob mouse. Serum leptin was more highly correlated with fat deposition than with food intake indicating that the response in serum leptin was primarily due to increased fat deposition rather than to higher energy intake per se. The low correlations between serum leptin measured at 30 kg and performance test traits indicate that serum leptin would not be efficient for selection of animals prior to performance test. However, the consistent positive correlations between serum leptin and a measure of fat deposition suggest that serum leptin could usefully be incorporated in selection criteria for genetic improvement of carcass lean content in pigs.

Energy and applicator size and shape used in over 800 intraoperative electron beam therapy fields.

Intraoperative radiotherapy is a treatment option for some patients with locally advanced malignancies. This report updates the Mayo Clinic experience in more than 800 patients by analyzing the use of electron energy and cone size and shape by disease site between 1981 and 1996.

Calculating dose distributions and wedge factors for photon treatment fields with dynamic wedges based on a convolution/superposition method.

A convolution/superposition based method was developed to calculate dose distributions and wedge factors in photon treatment fields generated by dynamic wedges. This algorithm used a dual source photon beam model that accounted for both primary photons from the target and secondary photons scattered from the machine head. The segmented treatment tables (STT) were used to calculate realistic photon fluence distributions in the wedged fields. The inclusion of the extra-focal photons resulted in more accurate dose calculation in high dose gradient regions, particularly in the beam penumbra. The wedge factors calculated using the convolution method were also compared to the measured data and showed good agreement within 0.5%. The wedge factor varied significantly with the field width along the moving jaw direction, but not along the static jaw or the depth direction. This variation was found to be determined by the ending position of the moving jaw, or the STT of the dynamic wedge. In conclusion, the convolution method proposed in this work can be used to accurately compute dose for a dynamic or an intensity modulated treatment based on the fluence modulation in the treatment field.

Calculating dose and output factors for wedged photon radiotherapy fields using a convolution/superposition method.

We have developed a convolution/superposition method to calculate dose distributions in photon treatment fields with beam modifiers such as physical wedges. The dose component due to wedge generated radiation was accounted for by using an extended phantom model, which integrated a wedge, an air gap, and a patient phantom as the calculation phantom. The inhomogeneities in the extended phantom and the effect of beam hardening by the wedge were both corrected for in the convolution dose calculation. The calculated dose was verified by Monte Carlo simulation of the same extended phantom. A new dual photon source model was also used in the convolution method to account for both primary photons from the target and extra-focal photons from the primary collimator and flattening filter. Thus, realistic photon energy fluence distributions in the extended phantom were used for the dose calculation. The calculated dose distributions and the wedge factors agreed with the measured data within 2% for a variety of treatment fields including asymmetric fields. Our results showed that the wedge-generated radiation could contribute a significant fraction of the total dose in patients. This dose component depends on a specific field configuration, thus wedge factor changes with photon energy, wedge angle, field size, depth, and patient phantom SSD. The variation of the wedge factor can be predicted accurately by our convolution approach with the extended phantom model, which allows for more accurate dose or monitor unit computation for photon fields with beam modifiers.

Correcting kernel tilting and hardening in convolution/superposition dose calculations for clinical divergent and polychromatic photon beams.

To account for clinical divergent and polychromatic photon beams, we have developed kernel tilting and kernel hardening correction methods for convolution dose calculation algorithms. The new correction methods were validated by Monte Carlo simulation. The accuracy and computation time of the our kernel tilting and kernel hardening correction methods were also compared to the existing approaches including terma divergence correction, dose divergence correction methods, and the effective mean kernel method with no kernel hardening correction. Treatment fields of 10 x 10-40 x 40 cm2 (field size at source to axis distance (SAD)) with source to source distances (SSDs) of 60, 80, and 100 cm, and photon energies of 6, 10, and 18 MV have been studied. Our results showed that based on the relative dose errors at a depth of 15 cm along the central axis, the terma divergence correction may be used for fields smaller than 10 x 10 cm2 with a SSD larger than 80 cm; the dose divergence correction with an additional kernel hardening correction can reduce dose error and may be more applicable than the terma divergence correction. For both these methods, the dose error increased linearly with the depth in the phantom; the 90% isodose lines at the depth of 15 cm were shifted by about 2%-5% of the field width due to significant underestimation of the penumbra dose. The kernel hardening effect was less prominent than the kernel tilting effect for clinical photon beams. The dose error by using nonhardening corrected kernel is less than 2.0% at a depth of 15 cm along the central axis, yet it increased with a smaller field size and lower photon energy. The kernel hardening correction could be more important to compute dose in the fields with beam modifiers such as wedges when beam hardening is more significant. The kernel tilting correction and kernel hardening correction increased computation time by about 3 times, and 0.5-1 times, respectively. This can be justified by more accurate dose calculations for the majority of clinical treatments.

Measuring dose distributions for enhanced dynamic wedges using a multichamber detector array.

This paper investigates measuring dose distributions for enhanced dynamic wedges (EDWs) using a commercial multichamber detector array. The technical aspects of using the chamber array, including chamber calibration, selection of measurement parameters, and use of the reference chamber, have been fully investigated. The measurement results from the chamber array were also confirmed by those from the single chamber and radiographic film measurements. The results reported here showed that proper operation of the chamber array is essential to measure dose accurately for the EDW fields; the chamber detector array can be used more efficiently than a single chamber without compromising the dose measurement accuracy.

Thinking about thinking.

BACKGROUND: The nursing leadership at a 900-bed tertiary-care facility in the southeast believed an opportunity existed to improve the critical thinking abilities of the professional nursing staff. METHOD: A team, consisting of a diversified group of nurse educators and managers, had the opportunity to gain understanding of the critical thinking process of the nursing staff as well as to develop a plan designed to improve critical thinking skills. RESULTS: Outputs of the team included development of a critical thinking model and process as well as an action plan that specifically outlined how it would implement the model within the organization using a preceptor-based educational process. CONCLUSION: Nursing leadership within this facility believes that nurturing critical thinking in the staff will have a positive impact on care delivery outcomes. Creating shared visions through the assumptions that the staff and organization hold is important to improving care provided. Assisting staff with using a critical thinking process in order to construct, tear down, and then reconstruct clinical incidents as encouraged by this model is one key to problem-solving.

A dual source photon beam model used in convolution/superposition dose calculations for clinical megavoltage x-ray beams.

A realistic model of photon beams generated by clinical linear accelerators has been incorporated in a convolution/superposition method to compute dose distributions in photon treatment fields. In this beam model, a primary photon source represents photons directly from the target, and an extra-focal photon source represents scattered photons from the primary collimator and the flattening filter. Monte Carlo simulation was used to study clinical linear accelerators producing photon beams. From the output of the Monte Carlo simulation, the fluence and spectral distributions of each photon component, as well as the geometrical characteristics of each photon source with respect to its distance to the isocenter and its source distribution, were analyzed. These quantities were used to reproduce realistic photon distributions in treatment fields, and thus to compute dose distributions using the convolution method. Our results showed that compared to the primary photon fluence, the extra-focal photon fluence from the primary collimator and the flattening filter was 11%-16% at the isocenter, among which 70% was contributed by the flattening filter. The variation of extra-focal photons in different treatment fields was predicted accurately by accounting for the finite size of the extra-focal source. Compared to measurements, dose distributions in photon treatment fields, including those of asymmetric jaw settings and at different SSDs were calculated accurately, particularly in the penumbral region, by using the convolution method with the new dual source photon beam model.

Calculating output factors for photon beam radiotherapy using a convolution/superposition method based on a dual source photon beam model.

A realistic photon beam model based on Monte Carlo simulation of clinical linear accelerators was implemented in a convolution/superposition dose calculation algorithm. A primary and an extra-focal sources were used in this beam model to represent the direct photons from the target and the scattered photons from other head structures, respectively. The effect of the finite size of the extra-focal source was modeled by a convolution of the source fluence distribution with the collimator aperture function. Relative photon output in air (Sc) and in phantom (Scp) were computed using the convolution method with this new photon beam model. Our results showed that in a 10 MV photon beam, the Sc, Sp (phantom scatter factor), and Scp factors increased by 11%, 10%, and 22%, respectively, as the field size changed from 3 x 3 cm2 to 40 x 40 cm2. The variation of the Sc factor was contributed mostly by an increase of the extra-focal radiation with field size. The radiation backscattered into the monitor chamber inside the accelerator head affected the Sc by about 2% in the same field range. The output factors in elongated fields, asymmetric fields, and blocked fields were also investigated in this study. Our results showed that if the effect of the backscattered radiation was taken into account, output factors in these treatment fields can be predicted accurately by our convolution algorithm using the dual source photon beam model.

Computers and medical information: an elective for fourth-year medical students.

The Computers and Medical Information elective is a collaborative effort to expose students to a variety of computer applications for medical information management. The course has a modular format so that students can work with a variety of people who are enthusiastic users of computer-based information systems. The elective emphasizes learning by doing. Faculty introduce concepts and systems and serve as guides in the use of systems. Students have rated the course positively and, after four years as an elective, some of the course's content has been integrated into the required curriculum.

Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the Radiation Therapy Committee, American Association of Physicists in Medicine.

Intraoperative radiation therapy (IORT) is a treatment modality whereby a large single dose of radiation is delivered to a surgically open, exposed cancer site. Typically, a beam of megavoltage electrons is directed at an exposed tumor or tumor bed through a specially designed applicator system. In the last few years, IORT facilities have proliferated around the world. The IORT technique and the applicator systems used at these facilities vary greatly in sophistication and design philosophy. The IORT beam characteristics vary for different designs of applicator systems. It is necessary to document the existing techniques of IORT, to detail the dosimetry data required for accurate delivery of the prescribed dose, and to have a uniform method of dose specification for cooperative clinical trials. The specific charge to the task group includes the following: (a) identify the multidisciplinary IORT team, (b) outline special considerations that must be addressed by an IORT program, (c) review currently available IORT techniques, (d) describe dosimetric measurements necessary for accurate delivery of prescribed dose, (e) describe dosimetric measurements necessary in documenting doses to the surrounding normal tissues, (f) recommend quality assurance procedures for IORT, (g) review methods of treatment documentation and verification, and (h) recommend methods of dose specification and recording for cooperative clinical trials.

The use of a radiochromic detector for the determination of stereotactic radiosurgery dose characteristics.

The measurement of absorbed dose as well as dose distributions (profiles and isodose curves) for small radiation fields (as encountered in stereotactic surgery) has been difficult due to the usual large detector size or densitometer aperture (> 1 mm) relative to the radiation field (as small as 4 mm). The radiochromic direct-imaging film, when read with a scanning laser microdensitometer (laser beam diameter 0.1 mm), overcomes this difficulty and has advantages over conventional film in providing improved precision, better tissue equivalence, greater dynamic range, higher spatial resolution, and room light handling. As a demonstration of suitability, the calibrated radiochromic film has been used to measure the dose characteristics for the 18-, 14-, 8-, and 4-mm fields from the gamma-ray stereotactic surgery units at Mayo Clinic and the University of Pittsburgh. Intercomparisons of radiochromic film with conventional methods of dosimetry and vendor-supplied computational dose planning system values indicate agreement to within +/- 2%. The dose, dose profiles, and isodose curves obtained with radiochromic film can provide high-spatial-resolution information of value for acceptance testing and quality control of dose measurement and/or calculation.