Exploration of the Two-Electron Excitation Space with Data-Driven Coupled Cluster.

Computational cost limits the applicability of post-Hartree-Fock methods such as coupled-cluster on larger molecular systems. The data-driven coupled-cluster (DDCC) method applies machine learning to predict the coupled-cluster two-electron amplitudes (t2) using data from second-order perturbation theory (MP2). One major limitation of the DDCC models is the size of training sets that increases exponentially with the system size. Effective sampling of the amplitude space can resolve this issue. Five different amplitude selection techniques that reduce the amount of data used for training were evaluated, an approach that also prevents model overfitting and increases the portability of data-driven coupled-cluster singles and doubles to more complex molecules or larger basis sets. In combination with a localized orbital formalism to predict the CCSD t2 amplitudes, we have achieved a 10-fold error reduction for energy calculations.

Curating a body-positive feed? An attempt to mitigate the negative impacts of thin-ideal content on Instagram.

Over the last decade, research has shown a negative relationship between social media use and body image. For women, these adverse effects tend to result from viewing content that promotes thinness as the ideal body type. Attempts to mitigate these adverse effects using disclaimers have failed. In the current study, we tested whether interspersing thin-ideal content with body-positive posts can mitigate the impact of thin-ideal content. The current study had six conditions. In three conditions, participants were exposed to 20 images of either thin-ideal, body-positive, or nature (control) images from Instagram. In the remaining three conditions, we interspersed the 20 images from the thin-deal condition with either 1 (i.e., 1:20 condition), 2 (i.e., 1:10 condition), or 4 (i.e., 1:5 condition) body-positive posts. For all six conditions, body satisfaction, body appreciation, appearance self-esteem, positive affect, and negative affect were measured before and after exposure. Our results demonstrated that irrespective of frequency, interspersing thin-ideal content with body-positive content did not mitigate decreases in body satisfaction, body appreciation, appearance self-esteem, or positive affect. Our failure to mitigate the negative impact of thin-ideal content adds to a growing body of work demonstrating that combating the impact of thin-ideal content on Instagram is extremely difficult.

Time to Extubation Among ARDS Subjects With and Without COVID-19 Pneumonia.

BACKGROUND: Pneumonia from COVID-19 that results in ARDS may require invasive mechanical ventilation. This retrospective study assessed the characteristics and outcomes of subjects with COVID-19-associated ARDS versus ARDS (non-COVID) during the first 6 months of the COVID-19 pandemic in 2020. The primary objective was to determine whether mechanical ventilation duration differed between these cohorts and identify other potential contributory factors. METHODS: We retrospectively identified 73 subjects admitted between March 1 and August 12, 2020, with either COVID-19-associated ARDS (37) or ARDS (36) who were managed with the lung protective ventilator protocol and required >48 h of mechanical ventilation. Exclusion criteria were the following: <18 years old or the patient required tracheostomy or interfacility transfer. Demographic and baseline clinical data were collected at ARDS onset (ARDS day 0), with subsequent data collected on ARDS days 1-3, 5, 7, 10, 14, and 21. Comparisons were made by using the Wilcoxon rank-sum test (continuous variables) and chi-square test (categorical variables) stratified by COVID-19 status. A Cox proportional hazards model assessed the cause-specific hazard ratio for extubation. RESULTS: The median (interquartile range) mechanical ventilation duration among the subjects who survived to extubation was longer in those with COVID-19-ARDS versus the subjects with non-COVID ARDS: 10 (6-20) d versus 4 (2-8) d; P < .001. Hospital mortality was not different between the two groups (22% vs 39%; P = .11). The competing risks Cox proportional hazard analysis (fit among the total sample, including non-survivors) revealed that improved compliance of the respiratory system and oxygenation were associated with the probability of extubation. Oxygenation improved at a lower rate in the subjects with COVID-19-associated ARDS than in the subjects with non-COVID ARDS. CONCLUSIONS: Mechanical ventilation duration was longer in subjects with COVID-19-associated ARDS compared with the subjects with non-COVID ARDS, which may be explained by a lower rate of improvement in oxygenation status.

Measure by measure: Resting heart rate across the 24-hour cycle.

BACKGROUND: Photoplethysmography (PPG) sensors, typically found in wrist-worn devices, can continuously monitor heart rate (HR) in large populations in real-world settings. Resting heart rate (RHR) is an important biomarker of morbidities and mortality, but no universally accepted definition nor measurement criteria exist. In this study, we provide a working definition of RHR and describe a method for accurate measurement of this biomarker, recorded using PPG derived from wristband measurement across the 24-hour cycle. METHODS: 433 healthy subjects wore a wrist device that measured activity and HR for up to 3 months. HR during inactivity was recorded and the duration of inactivity needed for HR to stabilise was ascertained. We identified the lowest HR during each 24-hour cycle (true RHR) and examined the time of day or night this occurred. The variation of HR during inactivity through the 24-hour cycle was also assessed. The sample was also subdivided according to daily activity levels for subset analysis. FINDINGS: Adequate data was obtained for 19,242 days and 18,520 nights. HR stabilised in most subjects after 4 minutes of inactivity. Mean (SD) RHR for the sample was 54.5 (8.0) bpm (day) and 50.5 (7.6) bpm (night). RHR values were highest in the least active group (lowest MET quartile). A circadian variation of HR during inactivity was confirmed, with the lowest values being between 0300 and 0700 hours for most subjects. INTERPRETATION: RHR measured using a PPG-based wrist-worn device is significantly lower at night than in the day, and a circadian rhythm of HR during inactivity was confirmed. Since RHR is such an important health metric, clarity on the definition and measurement methodology used is important. For most subjects, a minimum rest time of 4 minutes provides a reliable measurement of HR during inactivity and true RHR in a 24-hour cycle is best measured between 0300 and 0700 hours. Funding: This study was funded by Google.

#Bodypositive surpasses 1 billion engagements.

The body-positive movement (#bodypositive) champions body acceptance by celebrating a diverse - visual - array of body types and shapes online. Sparked out of collective resistance to unrealistic bodies on social media, the #bodypositive community has assembled a considerable following: having now surpassed one billion engagements on Instagram. To mark this milestone, we highlight the problem, the promise, and the peril of image-focused movements on Instagram. On balance, we argue #bodypositive content on Instagram likely has a positive impact. As the movement continues to grow though, advocates can look to strengthen the content's positive impact with some careful, research-informed, messaging adjustments.

Expiratory Pause Maneuver to Assess Inspiratory Muscle Pressure During Assisted Mechanical Ventilation: A Bench Study.

BACKGROUND: The generation of excessive inspiratory muscle pressure (Pmus) during assisted mechanical ventilation in patients with respiratory failure may result in acute respiratory muscle injury and/or fatigue, and exacerbate ventilator-induced lung injury. A readily available noninvasive surrogate measure of Pmus may help in titrating both mechanical ventilation and sedation to minimize these risks. This bench study explored the feasibility and accuracy of using a ventilator's expiratory pause hold function to measure Pmus across multiple operators. METHODS: A standardized technique for executing a brief (<1 s) expiratory pause maneuver was used to measure the airway occlusion pressure change (Δ Paw) by using 3 simulated Pmus (Δ Pmus: 5, 10, 15 cm H2O) under (1) pressure support ventilation (0, 10, 15 cm H2O), (2) volume and pressure-regulated volume ventilation, (3) flow and pressure-triggering, and (4) varying levels of PEEP and pressure-rise time. Individual and grouped measurements were made by 4-7 clinicians on 3 different ventilators. The concordance between occlusion Δ Paw and Δ Pmus was arbitrarily set at ≤ 2 cm H2O. Data were evaluated by using analysis of variance and the Tukey-Kramer posttest. Correlation was assessed by using the Pearson R test; bias and precision were assessed by using the Bland-Altman method. Alpha was set at 0.05. RESULTS: Grouped expiratory pause maneuver measurements of occlusion Δ Paw across simulated Δ Pmus, mode and level of ventilatory support showed reasonable concordance, regardless of the ventilator used. Occlusion Δ Paw accuracy frequently decreased by ∼3 cm H2O when both pressure support ventilation and Δ Pmus reached 15 cm H2O. Expiratory pause maneuver accuracy was not affected by trigger mechanism and/or sensitivity, PEEP, or the post-trigger pressurization rate. In general, only small differences in Δ Paw occurred among the individual operators. CONCLUSIONS: The expiratory pause maneuver generally provided reproducible, stable approximations of Δ Pmus across ventilators and ventilator settings, and a range of simulated effort. Technique standardization produced relatively consistent results across multiple operators. The expiratory pause maneuver seemed feasible for general use in monitoring inspiratory effort during assisted mechanical ventilation.

Insufficient Access: Naloxone Availability to Laypeople in Arizona and Indiana, 2018.

OBJECTIVES: To understand naloxone availability to laypeople in Arizona (Ariz.) and Indiana (Ind.). METHODS: Multi-source search conducted from May-December 2018 identifi ed the extent of naloxone availability to laypeople. Internet searches, email follow up, and phone interviews occurred with registered naloxone providers. RESULTS: Th ere were 89 naloxone providers in each state. Laypeople were ineligible for access for over half of registered naloxone providers in Ariz. (60.7%) and Ind. (55.1%). Naloxone access was mostly (67.4%) passive in Ariz. but was actively distributed in Ind. (67.4%). Syringe service programs (SSP) were the most frequently identifi ed providers of naloxone to laypeople in Ariz. (20.0%). In Ind., local health departments were most frequently identifi ed as layperson naloxone providers (75.0%). CONCLUSIONS: Less than half of registered naloxone providers allowed layperson access in Arizona and Indiana. Th e lack of layperson access highlights the need to review organization practice and state policy to ensure increased layperson access.

Deep eutectic solvents for solid pesticide dosage forms.

Deep eutectic solvents aid the formulation of solid pesticide dosage forms for water-insoluble actives. This was demonstrated by encapsulating Amitraz powder in a low-melting matrix based on the eutectic mixture of urea (32 wt%) and 1,3-dimethylurea. Dissolution in water of melt-cast discs, containing 20 wt% active, led to the rapid release of Amitraz in a finely dispersed form. The order of magnitude reduction in particle size, after dissolution, is ascribed to the solubilization of Amitraz in the hot deep eutectic solvent and its subsequent precipitation as a separate phase on crystallization of the matrix.

Dextrin Nanocomposites as Matrices for Solid Dosage Forms.

Safe application of water-insoluble acaricides requires fast release from solid dosage systems into aquatic environments. Dextrin is a water-soluble form of partially hydrolyzed starch, which may be used as matrix material for these systems if retrogradation can be inhibited by the inclusion of nanofillers. Several glycerol-plasticized thermoplastic dextrin-based nanocomposites were prepared with a twin-screw extrusion-compounding process. The nanofillers included a layered double hydroxide (LDH), cellulose nanofibers (CNF), and stearic acid. The time-dependent retrogradation of the compounds was monitored by X-ray diffraction (XRD) and dynamic mechanical thermal analysis (DMA). XRD showed that composite samples that included stearic acid in the formulation led to the formation of an amylose-lipid complex and a stable crystallinity during aging. The most promising nanocomposite included both stearic acid and CNF. It was selected as the carrier material for the water-insoluble acaricide Amitraz. Fast release rates were observed for composites containing 5, 10, and 20% (w/w) of the pesticide. A significant reduction in the particle size of the released Amitraz powder was observed, which is ascribed to the high-temperature compounding procedure.

A Novel Photoplethysmography Sensor for Vital Signs Monitoring from the Human Trachea.

Current pulse oximeter sensors can be challenged in working accurately and continuously in situations of reduced periphery perfusion, especially among anaesthetised patients. A novel tracheal photoplethysmography (PPG) sensor has been developed in an effort to address the limitations of current pulse oximeters. The sensor has been designed to estimate oxygen saturation (SpO2) and pulse rate, and has been manufactured on a flexible printed circuit board (PCB) that can adhere to a standard endotracheal (ET) tube. A pilot clinical trial was carried out as a feasibility study on 10 anaesthetised patients. Good quality PPGs from the trachea were acquired at red and infrared wavelengths in all patients. The mean SpO2 reading for the ET tube was 97.1% (SD 1.0%) vs. the clinical monitor at 98.7% (SD 0.7%). The mean pulse rate for the ET sensor was 65.4 bpm (SD 10.0 bpm) vs. the clinical monitor at 64.7 bpm (SD 9.9 bpm). This study supports the hypothesis that the human trachea could be a suitable monitoring site of SpO2 and other physiological parameters, at times where the periphery circulation might be compromised.

Validation of a model for physical dose variations in irregularly moving targets treated with carbon ion beams.

PURPOSE: In particle therapy, conventional treatment planning systems rely on an imaging representation of the irradiated region to compute the dose. For irregular breathing, when an imaging dataset describing the actual motion is not available, a different approach for dose estimation is needed. To this aim, we validate a method for the estimation of physical dose variations in gated carbon ion treatments, providing also a demonstration of the feasibility of physical dose metrics to assess the method performance. Finally, we describe a sample use case, in which this method is used to assess plan robustness with respect to undetected irregular tumor motion. METHODS: The method entails the definition of a patient- and beam-specific water equivalent depth (WED) space, the simulation of motion as a translation equal to tumor displacement, and the reconstruction of the altered dose. We validated the approach using four-dimensional computed tomographies (4DCTs) and clinical plans in 12 patients, treated with respiratory gated carbon ion beams at the National Centre for Oncological Hadrontherapy (Pavia, Italy). Using the end-exhale CT and dose distribution as a reference, the physical dose delivered at the end-inhale tumor position was estimated and compared to the ground-truth dose recalculation on the end-inhale CT. Biologically effective and physical dose variations between the plan and the recalculation were compared as well. As a use case, we evaluated dose changes caused by simulated irregular tumor motion, that is, linear and nonlinear baseline shifts and/or amplitude variations with hysteresis. RESULTS: The ratio between biologically effective and physical equivalent uniform dose (EUD) variations due to end-exhale to end-inhale motion was less than one for 96% of investigated structures. In the validation study, we found a median error corresponding to a 14% EUD overestimation for the tumor and 4% EUD underestimation for a subgroup of organs at risk, together with a high EUD variation due to motion [median 352% EUD variation between end-exhale and end-inhale doses in the planning tumor volume (PTV)]. Considering relevant dose-volume histogram (DVH) metrics, the median difference between estimated and ground truth doses was ≤ 4%. Gamma analysis between estimated and recalculated dose distributions resulted in a pass rate > 80% for 83% of the target volumes. For the two patients selected for the sample use case, a patient-specific assessment of the method performance was performed on the 4DCT and it was possible to relate EUD variations of both tumor and organs at risk to the simulated target motion. CONCLUSIONS: The physical dose distribution was found to be more sensitive to motion with respect to the biologically effective one, suggesting the suitability of the physical dose metrics for the WED-space method validation. We showed that the method can compensate for intra-fractional tumor motion with proper accuracy in the selected patient group, although its use is recommended when limited deformations are expected. In conclusion, the WED-space method can provide simulations of dose alteration due to irregular breathing when imaging data are lacking, and, once integrated with relative biological effectiveness (RBE) modeling, it would be useful in evaluating the robustness of carbon ion treatment plans.

Optimizing beam models for dosimetric accuracy over a wide range of treatments.

This work presents a systematic approach for testing a dose calculation algorithm over a variety of conditions designed to span the possible range of clinical treatment plans. Using this method, a TrueBeam STx machine with high definition multi-leaf collimators (MLCs) was commissioned in the RayStation treatment planning system (TPS). The initial model parameters values were determined by comparing TPS calculations with standard measured depth dose and profile curves. The MLC leaf offset calibration was determined by comparing measured and calculated field edges utilizing a wide range of MLC retracted and over-travel positions. The radial fluence was adjusted using profiles through both the center and corners of the largest field size, and through measurements of small fields that were located at highly off-axis positions. The flattening filter source was adjusted to improve the TPS agreement for the output of MLC-defined fields with much larger jaw openings. The MLC leaf transmission and leaf end parameters were adjusted to optimize the TPS agreement for highly modulated intensity-modulated radiotherapy (IMRT) plans. The final model was validated for simple open fields, multiple field configurations, the TG 119 C-shape target test, and a battery of clinical IMRT and volumetric-modulated arc therapy (VMAT) plans. The commissioning process detected potential dosimetric errors of over 10% and resulted in a final model that provided in general 3% dosimetric accuracy. This study demonstrates the importance of using a variety of conditions to adjust a beam model and provides an effective framework for achieving high dosimetric accuracy.

The Sensing Endotracheal Tube.

Current pulse oximetry sensors are not very well suited to use in anaesthetised patients as it has been shown that during episodes of reduced peripheral circulation they do not function correctly or fail all together [1], [2]. To address this problem a new design for a photoplethysmography (PPG) endotracheal (ET) sensor to monitor pulse rate and oxygen saturation (SpO2) internally is presented. Flexible printed circuit board (PCB) technology and miniature optoelectronic components have been implemented and integrated with a custom instrumentation system [3]. The sensor adheres and conforms to the curvature of standard french-gauge 7 and 8 ET tubes at the point just above the inflatable cuff within the laryngeal positioning markings. A 3D-modelled, optically clear, soft silicon encapsulation electronically and thermally isolates the electronic components whilst providing a smooth surface to aid the insertion on the ET tube during standard intubation procedures. A pilot study with 5 patients (3 Female, 2 Male), undergoing abdominal and limb laproscopic procedures has demonstrated the operation of the sensing ET tube, showing good quality red and infra-red PPG signals. Preliminary signal analysis reveals heart rate can be measured via PPG successfully, with saturation (SpO2) readings in close agreement with the commercial monitors of 97.9 % (STD 0.2 %) and 98.6 % (STD 0.8 %) respectively.

Investigating optical path and differential pathlength factor in reflectance photoplethysmography for the assessment of perfusion.

Photoplethysmography (PPG) is an optical noninvasive technique with the potential for assessing tissue perfusion. The relative time-change in the concentration of oxyhemoglobin and deoxyhemoglobin in the blood can be derived from DC part of the PPG signal. However, the absolute concentration cannot be determined due to the inadequate data on PPG optical paths. The optical path and differential pathlength factor (DPF) for PPG at red (660 nm) and infrared (880 nm) wavelengths were investigated using a heterogeneous Monte Carlo model of the human forearm. Using the simulated DPFs, the absolute time-change in concentrations were determined from PPG signals recorded from the same tissue site. Results were compared with three conditions of approximated DPFs. Results showed the variation of the optical-path and DPF with different wavelengths and source-detector separations. Approximations resulted in significant errors, for example, using NIRS DPF in PPG led to "cross talk" of -0.4297 and 0.060 and an error of 15.16% to 25.18%. Results confirmed the feasibility of using the PPG (DC) for the assessment of tissue perfusion. The study also identified the inappropriateness of the assumption that DPF is independent of wavelength or source-detector separations and set the platform for further studies on investigating optical pathlengths and DPF in PPG.

Patient-Specific Fetal Dose Determination for Multi-Target Gamma Knife Radiosurgery: Computational Model and Case Report.

A 42-year-old woman at 29 weeks gestation via in vitro fertilization who presented with eight metastatic brain lesions received Gamma Knife stereotactic radiosurgery (GKSRS) at our institution. In this study, we report our clinical experience and a general procedure of determining the fetal dose from patient-specific treatment plans and we describe quality assurance measurements to guide the safe practice of multi-target GKSRS of pregnant patients. To estimate fetal dose pre-treatment, peripheral dose-to-focal dose ratios (PFRs) were measured in a phantom at the distance approximating the fundus of uterus. Post-treatment, fetal dose was calculated from the actual patient treatment plan. Quality assurance measurements were carried out via the extrapolation dosimetry method in a head phantom at increasing distances along the longitudinal axis. The measurements were then empirically fitted and the fetal dose was extracted from the curve. The computed and measured fetal dose values were compared with each other and associated radiation risk was estimated. Based on low estimated fetal dose from preliminary phantom measurements, the patient was accepted for GKSRS. Eight brain metastases were treated with prescription doses of 15-19 Gy over 143 min involving all collimator sizes as well as composite sector mixed shots. Direct fetal dose computation based on the actual patient's treatment plan estimated a maximum fetal dose of 0.253 cGy, which was in agreement with surface dose measurements at the level of the patient's uterine fundus during the actual treatment. Later phantom measurements also estimated fetal dose to be in the range of 0.21-0.28 cGy (dose extrapolation curve R2 = 0.998). Using the National Council on Radiation Protection and Measurements (NCRP) population-based model, we estimate the fetal risk of secondary malignancy, which is the primary toxicity after 25 weeks gestation, to be less than 0.01%. Of note, the patient delivered the baby via scheduled cesarean section at 36 weeks without complications attributable to the GKSRS procedure. GKSRS of multiple brain metastases was demonstrated to be safe and feasible during pregnancy. The applicability of a general patient-specific fetal dose determination method was also demonstrated for the first time for such a treatment.

Severity of Hypoxemia and Other Factors That Influence the Response to Aerosolized Prostacyclin in ARDS.

BACKGROUND: ARDS is characterized by decreased functional residual capacity (FRC), heterogeneous lung injury, and severe hypoxemia. Tidal ventilation is preferentially distributed to ventilated alveoli. Aerosolized prostaglandin I2 exploits this pathophysiology by inducing local vasodilation, thereby increasing ventilation-perfusion matching and reducing hypoxemia. Therefore, aerosolized prostaglandin I2 efficacy may depend upon FRC. Both PaO2 /FIO2 and compliance of the respiratory system (CRS) are indirect signifiers of FRC and thus may partly determine the response to aerosolized prostaglandin I2. METHODS: We reviewed the records of 208 ARDS subjects who received aerosolized prostaglandin I2 and had arterial blood gases done before and after the initiation of therapy, without other ventilator manipulations. Subjects were grouped according to baseline PaO2 /FIO2 (lowest: < 60, intermediate: 60-90, highest: > 90 mm Hg) and CRS (< 20, 20-29, 30-39, and ≥ 40 mL/cm H2O) and by other factors, such as sepsis. Comparisons were analyzed by paired t tests, or Kruskal-Wallis and Dunn post-tests. Multivariate logistic regression modeling was done to determine which of 18 clinically relevant factors were most predictive for responding to aerosolized prostaglandin I2. α was set at .05. RESULTS: Mean PaO2 /FIO2 increased by 33 mm Hg (42%) upon initiation of prostaglandin I2, with a responder rate of 62%. PaO2 /FIO2 increased significantly in all oxygenation groups. The highest baseline PaO2 /FIO2 group had the greatest improvement and responder rate (51 ± 63 mm Hg, and 82%). In addition, those with sepsis had a smaller improvement in PaO2 /FIO2 compared with those without sepsis (18 ± 35 vs 40 ± 55 mm Hg, P = .002). Both PaO2 /FIO2 and responder rate increased as CRS improved, but between-group improvements were not as consistent. In the final model, the only factors that predicted a positive response to aerosolized prostaglandin I2 were baseline PaO2 /FIO2 (odds ratio 1.10 [1.004-1.205], P = .042) and CRS (odds ratio 1.04 [1.01-1.08], P = .02). CONCLUSIONS: Aerosolized prostaglandin I2 improves oxygenation in approximately 60% of ARDS cases. A favorable response was most strongly associated with baseline PaO2 /FIO2 and CRS.

Validating Dose Uncertainty Estimates Produced by AUTODIRECT: An Automated Program to Evaluate Deformable Image Registration Accuracy.

Deformable image registration is a powerful tool for mapping information, such as radiation therapy dose calculations, from one computed tomography image to another. However, deformable image registration is susceptible to mapping errors. Recently, an automated deformable image registration evaluation of confidence tool was proposed to predict voxel-specific deformable image registration dose mapping errors on a patient-by-patient basis. The purpose of this work is to conduct an extensive analysis of automated deformable image registration evaluation of confidence tool to show its effectiveness in estimating dose mapping errors. The proposed format of automated deformable image registration evaluation of confidence tool utilizes 4 simulated patient deformations (3 B-spline-based deformations and 1 rigid transformation) to predict the uncertainty in a deformable image registration algorithm's performance. This workflow is validated for 2 DIR algorithms (B-spline multipass from Velocity and Plastimatch) with 1 physical and 11 virtual phantoms, which have known ground-truth deformations, and with 3 pairs of real patient lung images, which have several hundred identified landmarks. The true dose mapping error distributions closely followed the Student t distributions predicted by automated deformable image registration evaluation of confidence tool for the validation tests: on average, the automated deformable image registration evaluation of confidence tool-produced confidence levels of 50%, 68%, and 95% contained 48.8%, 66.3%, and 93.8% and 50.1%, 67.6%, and 93.8% of the actual errors from Velocity and Plastimatch, respectively. Despite the sparsity of landmark points, the observed error distribution from the 3 lung patient data sets also followed the expected error distribution. The dose error distributions from automated deformable image registration evaluation of confidence tool also demonstrate good resemblance to the true dose error distributions. Automated deformable image registration evaluation of confidence tool was also found to produce accurate confidence intervals for the dose-volume histograms of the deformed dose.

Dual pO2/pCO2 fibre optic sensing film.

A fibre optic multi-sensor has been developed for biomedical sensing applications using a tip coating solution sensitive to both oxygen and carbon dioxide. An oxygen sensitive phosphorescence quenching complex based on platinum octaethylporphyrin (PtOEP) was combined with a carbon dioxide sensitive phosphorescence compound based on 8-hydroxypyrene-1,3,6-trisulfonic acid trisodium salt (HPTS). When excited by blue light (470 nm), the resultant coating had two fluorescent peaks at 515 nm (green) and 645 nm (red) which responded to partial pressure of CO2 and O2 respectively. The sensor was tested in vitro and shown to be able to measure CO2 and O2 simultaneously and in real time, with calibration constants of 0.0384 kPa-1 and 0.309 kPa-1 respectively. The O2 sensitive peak received some overlap from the 515 nm peak (0.38% of peak intensity) as well as some cross-sensitivity (maximum, 5.1 kPa pCO2 gave a measurement equivalent to 0.43 kPa of O2, a ratio of 0.08 : 1). However, these effects can be subtracted from measurements and no significant cross-sensitivity or overlap was seen in CO2 measurements from O2. This novel compound presents great potential for use in medical sensors and we expect it to be important to a wide range of future applications.

A Comparison of Different Techniques for Interfacing Capnography With Adult and Pediatric Supplemental Oxygen Masks.

BACKGROUND: Accurately measuring the partial pressure of end-tidal CO2 (PETCO2 ) in non-intubated patients is problematic due to dilution of expired CO2 at high O2 flows and mask designs that may either cause CO2 rebreathing or inadequately capture expired CO2. We evaluated the performance of 2 capnographic O2 masks (Cap-ONE and OxyMask) against a clinically expedient method using a standard O2 mask with a flow-directed nasal cannula used for capnography (CapnoLine) in a spontaneous breathing model of an adult and child under conditions of normal ventilation, hypoventilation, and hyperventilation. METHODS: An ASL-5000 simulator was attached to a manikin face with a catheter port, through which various CO2/air mixtures were bled into the ASL-5000 to achieve a PETCO2 of 40, 65, and 30 mm Hg. Both PETCO2 and inspired PCO2 were measured at O2 flows of 5, 10, 15, and 20 L/min (adult model) and 2, 4, 6, 8, and 10 L/min (pediatric model). RESULTS: PETCO2 decreased to varying degrees as O2 flow increased, depending upon the breathing pattern. Although all devices appeared to perform reasonably well under normal and hyperventilation conditions, the clinically expedient method was associated with substantially more CO2 rebreathing. PETCO2 usually deteriorated more under simulated hypoventilation, regardless of the measurement method. CONCLUSIONS: Both of the specially designed O2 capnography masks provided reasonably stable PETCO2 without significant CO2 rebreathing at the commonly used O2 flows. Because of their open design, PETCO2 measured at high O2 flows may produce artificially lower readings that may not reflect arterial CO2 levels compared with lower O2 flows.

Fiber-optic fluorescence-quenching oxygen partial pressure sensor using platinum octaethylporphyrin.

The development and bench testing of a fiber-optic oxygen sensor is described. The sensor is designed for measurement of tissue oxygen levels in the mucosa of the digestive tract. The materials and construction are optimized for insertion through the mouth for measurement in the lower esophagus. An oxygen-sensitive fluorescence-quenching film was applied as a solution of platinum octaethylporphyrin (PtOEP) poly(ethyl methacrylate) (PEMA) and dichloromethane and dip coated onto the distal tip of the fiber. The sensor was tested by comparing relative fluorescence when immersed in liquid water at 37°C, at a range of partial pressures (0-101 kPa). Maximum relative fluorescence at most oxygen concentrations was seen when the PtOEP concentration was 0.1 g.L-1, four layers of coating solution were applied, and a fiber core radius of 600 µm was selected, giving a Stern-Volmer constant of 0.129 kPa-1. The performance of the sensor is suitable for many in vivo applications, particularly mucosal measurements. It has sufficient sensitivity, is sterilizable, and is sufficiently flexible and robust for insertion via the mouth without damage to the probe or risk of harm to the patient.