Decompensated metabolic acidosis in the emergency department: Epidemiology, sodium bicarbonate therapy, and clinical outcomes.

Objective: This article aims to describe the epidemiology of decompensated metabolic acidosis, the characteristics of sodium bicarbonate (SB) administration and outcomes in emergency department (ED) patients.

Design: This is a retrospective cohort study.

Setting: ED of a tertiary referral hospital in Melbourne, Australia.

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management.

Objectives: As an alternative to conventional compression amidst the COVID-19 pandemic, we developed a contactless motion management strategy. By increasing the patient's breathing rate to induce shallow breathing with the aid of a metronome, our hypothesis is that the motion magnitude of the target may be minimized without physical contact or compression.

Methods: Fourteen lung stereotactic body radiation therapy (SBRT) patients treated under fast shallow-breathing (FSB) were selected for inclusion in this retrospective study.

Landscape diversity promotes stable food-web architectures in large rivers.

Uncovering relationships between landscape diversity and species interactions is crucial for predicting how ongoing land-use change and homogenization will impact the stability and persistence of communities. However, such connections have rarely been quantified in nature. We coupled high-resolution river sonar imaging with annualized energetic food webs to quantify relationships among habitat diversity, energy flux, and trophic interaction strengths in large-river food-web modules that support the endangered Pallid Sturgeon.

Invasive predator diet plasticity has implications for native fish conservation and invasive species suppression.

Diet plasticity is a common behavior exhibited by piscivores to sustain predator biomass when preferred prey biomass is reduced. Invasive piscivore diet plasticity could complicate suppression success; thus, understanding invasive predator consumption is insightful to meeting conservation targets. Here, we determine if diet plasticity exists in an invasive apex piscivore and whether plasticity could influence native species recovery benchmarks and invasive species suppression goals.

Reconstructing the history of helminth prevalence in the UK.

Intestinal helminth parasites (worms) have afflicted humans throughout history and their eggs are readily detected in archaeological deposits including at locations where intestinal parasites are no longer considered endemic (e.g. the UK).

The design of a novel direction modulated brachytherapy vaginal cylinder applicator for optimizing coverage of the apex.

Purpose: High-dose-rate (HDR) vaginal cuff brachytherapy is an effective adjuvant therapy for women with stage I endometrial cancer. Although infrequent, failures do occur, most frequently at the vaginal vault. A potential cause of failure is insufficient dosimetric coverage at the vaginal apex due to cold spots from the anisotropic dose distribution of the source.

A paradoxical knowledge gap in science for critically endangered fishes and game fishes during the sixth mass extinction.

Despite unprecedented scientific productivity, Earth is undergoing a sixth mass extinction. The disconnect between scientific output and species conservation may be related to scientists studying the wrong species. Given fishes have a high extinction rate, we assessed the paradox between scientific productivity and science needed for conservation by comparing scientific output created for critically endangered fishes and game fishes.

Epidemiological insights from a large-scale investigation of intestinal helminths in Medieval Europe.

Helminth infections are among the World Health Organization's top neglected diseases with significant impact in many Less Economically Developed Countries. Despite no longer being endemic in Europe, the widespread presence of helminth eggs in archaeological deposits indicates that helminths represented a considerable burden in past European populations. Prevalence of infection is a key epidemiological feature that would influence the elimination of endemic intestinal helminths, for example, low prevalence rates may have made it easier to eliminate these infections in Europe without the use of modern anthelminthic drugs.

Characterization of Respiration-Induced Motion in Prone Versus Supine Patient Positioning for Thoracic Radiation Therapy.

Purpose: Variations in the breathing characteristics, both on short term (intrafraction) and long term (interfraction) time scales, may adversely affect the radiation therapy process at all stages when treating lung tumors. Prone position has been shown to improve consistency (ie, reduced intrafraction variability) and reproducibility (ie, reduced interfraction variability) of the respiratory pattern with respect to breathing amplitude and period as a result of natural abdominal compression, with no active involvement required from the patient. The next natural step in investigating breathing-induced changes is to evaluate motion amplitude changes between prone and supine targets or organs at risk, which is the purpose of the present study.

Fatal Radiation Pneumonitis: Literature Review and Case Series.

Purpose: Fatal radiation pneumonitis is a rare event. In recent years, higher incidences of grade 5 pneumonitis have been reported. Based on 3 cases in our clinic, a literature review was performed to assess specific clinical features and risk factors for fatal pneumonitis.

A fast and scalable method for quality assurance of deformable image registration on lung CT scans using convolutional neural networks.

Purpose: To develop and evaluate a method to automatically identify and quantify deformable image registration (DIR) errors between lung computed tomography (CT) scans for quality assurance (QA) purposes.

Methods: We propose a deep learning method to flag registration errors. The method involves preparation of a dataset for machine learning model training and testing, design of a three-dimensional (3D) convolutional neural network architecture that classifies registrations into good or poor classes, and evaluation of a metric called registration error index (REI) which provides a quantitative measure of registration error.

The vaginal cylinder: Misunderstood, misused, or trivial? An in-depth dosimetric and multiinstitutional outcome investigation.

Purpose: The purpose of the study was to investigate the impact on dose distribution and radiobiological metrics of common high-dose-rate vaginal brachytherapy treatment parameters and to analyze multiinstitutional data for clinically significant impact on outcomes in early-stage endometrial cancer.

Methods And Materials: Treatment plans were created for all combinations of prescription parameters and used to quantify the dosimetric impact of each parameter and to estimate the dose delivered using common voxel-integrated radiobiological metrics. A rating system, based on risk grouping from GOG and PORTEC trials, was used to consolidate staging information into a cancer "aggressiveness" measure.

Dynamic Modulated Brachytherapy (DMBT) Balloon Applicator for Accelerated Partial Breast Irradiation.

Purpose: To propose a novel high-dose-rate brachytherapy applicator for balloon-based dynamic modulated brachytherapy (DMBT) for accelerated partial breast irradiation (APBI) and to demonstrate its dosimetric advantage compared to the widely used Contura applicator.

Methods And Materials: The DMBT balloon device consists of a fixed central channel enabling real-time, in vivo dosimetry and an outer motion-dynamic, adjustable-radius channel capable of moving to any angular position within the balloon. This design allows placement of dwell positions anywhere within the balloon volume, guaranteeing optimal placement and generation of the applicator and treatment plan, respectively.

Evaluation of Image Registration Accuracy for Tumor and Organs at Risk in the Thorax for Compliance With TG 132 Recommendations.

Purpose: To evaluate accuracy for 2 deformable image registration methods (in-house B-spline and MIM freeform) using image pairs exhibiting changes in patient orientation and lung volume and to assess the appropriateness of registration accuracy tolerances proposed by the American Association of Physicists in Medicine Task Group 132 under such challenging conditions via assessment by expert observers.

Methods And Materials: Four-dimensional computed tomography scans for 12 patients with lung cancer were acquired with patients in prone and supine positions. Tumor and organs at risk were delineated by a physician on all data sets: supine inhale (SI), supine exhale, prone inhale, and prone exhale.

Technical Note: A method for quality assurance of landmark sets for use in evaluation of deformable image registration accuracy of lung parenchyma.

Purpose: To develop a quality control method to improve the accuracy of corresponding landmark sets used for deformable image registration (DIR) evaluation in the lung parenchyma.

Methods: An iterative workflow was developed as a method for quality assurance of landmark sets. Starting with the initial landmark set for a given image pair, a landmark-based deformation was applied to one of the images.

Laboratory alerts to guide early intensive care team review in surgical patients: A feasibility, safety, and efficacy pilot randomized controlled trial.

Aim: Common blood tests can help identify patients at risk of death, unplanned intensive care unit (ICU) admission, or rapid response team (RRT) call. We aimed to test whether early ICU-team review triggered by such laboratory tests (lab alert) is feasible, safe, and can alter physiological variables, clinical management, and clinical outcomes.

Methods: In prospective pilot randomized controlled trial in surgical wards of a tertiary hospital, we studied patients admitted for >24 h.

CALIPER: A deformable image registration algorithm for large geometric changes during radiotherapy for locally advanced non-small cell lung cancer.

Purpose: Locally advanced non-small cell lung cancer (NSCLC) patients may experience dramatic changes in anatomy during radiotherapy and could benefit from adaptive radiotherapy (ART). Deformable image registration (DIR) is necessary to accurately accumulate dose during plan adaptation, but current algorithms perform poorly in the presence of large geometric changes, namely atelectasis resolution. The goal of this work was to develop a DIR framework, named Consistent Anatomy in Lung Parametric imagE Registration (CALIPER), to handle large geometric changes in the thorax.

Lung and Heart Dose Variability During Radiation Therapy of Non-Small Cell Lung Cancer.

Purpose: To investigate the hypothesis that positional and anatomic variations during radiation therapy induce changes in lung and heart volumes and associated radiation doses.

Methods And Materials: In this longitudinal investigation, variations in lung and heart volumes and standard dose parameters of mean lung dose, lung V, mean heart dose, and heart V were analyzed on weekly 4-dimensional CT scans of 15 lung cancer patients during conventionally fractionated radiochemotherapy. Tumor, individual lung lobes, and heart were delineated on the mid-ventilation phase of weekly 4-dimensional CT scans.

Clinically relevant investigation of flattening filter-free skin dose.

As flattening filter-free (FFF) photon beams become readily available for treat-ment delivery in techniques such as SBRT, thorough investigation of skin dose from FFF photon beams is necessary under clinically relevant conditions. Using a parallel-plate PTW Markus chamber placed in a custom water-equivalent phantom, surface-dose measurements were taken at 2 × 2, 3 × 3, 4 × 4, 6 × 6, 8 × 8, 10 × 10, 20 × 20, and 30 × 30 cm2 field sizes, at 80, 90, and 100 cm source-to-surface distances (SSDs), and with fields defined by jaws and multileaf collimator (MLC) using multiple beam energies (6X, 6XFFF, 10X, and 10XFFF). The same set of measurements was repeated with the chamber at a reference depth of 10cm.

Effect of atelectasis changes on tissue mass and dose during lung radiotherapy.

Purpose: To characterize mass and density changes of lung parenchyma in non-small cell lung cancer (NSCLC) patients following midtreatment resolution of atelectasis and to quantify the impact this large geometric change has on normal tissue dose.

Methods: Baseline and midtreatment CT images and contours were obtained for 18 NSCLC patients with atelectasis. Patients were classified based on atelectasis volume reduction between the two scans as having either full, partial, or no resolution.

Esterified eicosanoids are acutely generated by 5-lipoxygenase in primary human neutrophils and in human and murine infection.

5-Lipoxygenase (5-LOX) plays key roles in infection and allergic responses. Herein, four 5-LOX-derived lipids comprising 5-hydroxyeicosatetraenoic acid (HETE) attached to phospholipids (PLs), either phosphatidylethanolamine (PE) or phosphatidylcholine (18:0p/5-HETE-PE, 18:1p/5-HETE-PE, 16:0p/5-HETE-PE, and 16:0a/5-HETE-PC), were identified in primary human neutrophils. They formed within 2 minutes in response to serum-opsonized Staphylococcus epidermidis or f-methionine-leucine-phenylalanine, with priming by lipopolysaccharide, granulocyte macrophage colony-stimulating factor, or cytochalasin D.

Landscape influences on genetic differentiation among bull trout populations in a stream-lake network.

This study examined the influence of landscape heterogeneity on genetic differentiation between migratory bull trout (Salvelinus confluentus) populations in Glacier National Park, Montana. An information-theoretic approach was used to compare different conceptual models of dispersal associated with barriers, different models of isolation by distance, and the combined effects of barriers, waterway distance, patch size, and intra- and inter-drainage distribution of populations on genetic differentiation between bull trout populations. The effect of distance between populations on genetic differentiation was best explained by partitioning the effects of mainstem and tributary stream sections.

Reproductive health of bass in the Potomac, U.S.A., drainage: part 2. Seasonal occurrence of persistent and emerging organic contaminants.

The seasonal occurrence of organic contaminants, many of which are potential endocrine disruptors, entering the Potomac River, USA, watershed was investigated using a two-pronged approach during the fall of 2005 and spring of 2006. Passive samplers (semipermeable membrane device and polar organic chemical integrative sampler [POCIS]) were deployed in tandem at sites above and below wastewater treatment plant discharges within the watershed. Analysis of the samplers resulted in detection of 84 of 138 targeted chemicals.

Reproductive health of bass in the Potomac, U.S.A., drainage: part 1. Exploring the effects of proximity to wastewater treatment plant discharge.

Intersex (specifically, testicular oocytes) has been observed in male smallmouth bass (SMB; Micropterus dolomieu) and other centrarchids in the South Branch of the Potomac River, U.S.A.

Effects of sediment-bound zinc contamination on early life stages of the mummichog (Fundulus heteroclitus L.) in the Christina watershed, Delaware, U.S.A.

During the last century, the Christina River, the major estuarine river system in New Castle County (DE, USA), has received loadings of organic and inorganic chemicals, primarily from manufacturing facilities. Among the most abundant chemicals is zinc, which has accumulated in sediments at concentrations as high as 5,440 mg/kg. We studied the possible effects of zinc on early life stages of the mummichog (Fundulus heteroclitus), a resident species in the river and watershed.