Developmental stage and level of submersion in water impact the viability of lone star and winter tick eggs.

Female ticks deposit large egg clusters that range in size from hundreds to thousands. These egg clusters are restricted to a deposition site as they are stationary, usually under leaf litter and other debris. In some habitats, these sites can be exposed to periodic flooding.

A Four-dimensional Computed Tomography Generated Internal Target Volume Approach to Paediatric High Risk Neuroblastoma to Reduce Organ at Risk and Normal Tissue Irradiation.

Aims: The magnitude of upper abdominal organ motion in children may be overestimated by current planning target volumes (PTV). A four-dimensional computed tomography (4DCT) - derived internal target volume (ITV) is frequently used in adult radiotherapy to take respiratory-related organ motion into account. In this study, the dosimetric consequences for target coverage and organs at risk from the use of an ITV approach compared to standard PTV margins in children with high-risk neuroblastoma were investigated.

The IMRiS Trial: A Phase 2 Study of Intensity Modulated Radiation Therapy in Extremity Soft Tissue Sarcoma.

Purpose: Primary soft tissue sarcoma (STS) is rare, with many tumors occurring in extremities. Local management is limb-sparing surgery and preoperative/postoperative radiation therapy (RT) for patients at high risk of local recurrence. We prospectively investigated late normal tissue toxicity and limb function observed after intensity modulated RT (IMRT) in extremity STS.

Developmental stage and level of submersion in water impact the viability of lone star and winter tick eggs during flooding.

Female ticks deposit large egg clusters that range in size from hundreds to thousands. These clusters are restricted to a deposition site, usually under leaf litter and other debris. These sites can be exposed to periodic flooding, where the cluster of tick eggs can float to the surface or remain underneath organic debris entirely underwater.

A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma.

Background And Purpose: For high-risk neuroblastoma, planning target volume coverage is often compromised to respect adjacent kidney tolerance. This trial investigated whether intensity-modulated arc radiotherapy techniques (IMAT) could facilitate dose escalation better than conventional techniques.

Materials And Methods: Children with high-risk abdominal neuroblastoma referred for radiotherapy to the primary tumour site and involved regional lymph nodes were randomised to receive either standard dose (21 Gy in 14 fractions) or escalated dose (36 Gy in 24 fractions) radiotherapy.

Being kind in unkind spaces: a qualitative examination of how medical educators and first year medical students perceive empathy training.

Introduction: It has become for healthcare systems to tout their ability to provide compassionate medical care that addresses the emotional as well as physical needs of patients. Not surprisingly, then, there is considerable pressure on medical schools to train their students to be empathic. Existing literature on empathy training in medicine tends to focus on how to build emotional intelligence in individual trainees, largely ignoring the sociocultural factors that contribute to or thwart empathy development in medical school.

An exemplary model of genetic counselling for highly specialised services.

With genomic testing being increasingly integrated into every day clinical practice and a wide range of practitioners ordering genetic tests, it is important that the scope of the genetic counselling role continues to evolve alongside these changes. We present an exemplary role for genetic counsellors in a highly specialised service within England's National Health Service for people who have or are suspected to have rare genetic types of Ehlers Danlos syndrome. The service employs genetic counsellors and consultants from the fields of genetics and dermatology.

Short-Term Head-Out Whole-Body Cold-Water Immersion Facilitates Positive Affect and Increases Interaction between Large-Scale Brain Networks.

An emerging body of evidence indicates that short-term immersion in cold water facilitates positive affect and reduces negative affect. However, the neural mechanisms underlying these effects remain largely unknown. For the first time, we employed functional magnetic resonance imaging (fMRI) to identify topological clusters of networks coupled with behavioural changes in positive and negative affect after a 5 min cold-water immersion.

Mild-to-severe traumatic brain injury in children: altered cytokines reflect severity.

Background: Paediatric traumatic brain injury (TBI) is recognised to have significant longer-term neurocognitive effects. Childhood is a time of high risk for head injury. Functional recovery is variable with a combination of any or all of physical, cognitive and emotional impairment.

Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy.

Objective: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE).

Methods: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with four-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging.

Traumatic Brain Injury in Children: Glial fibrillary Acidic Protein and Clinical Outcomes.

Objectives: Glial fibrillary acidic protein (GFAP) is a neuronal protein released after traumatic brain injury (TBI) and detectable in serum samples. GFAP correlates with symptom severity in adults and may be a marker of brain injury in children with milder symptoms or preverbal children.

Methods: GFAP was examined in children with severe TBI (initial Glasgow Coma Scale score <8), with mild TBI (Glasgow Coma Scale score 14/15), and at 0 to 4 and at 10 to 14 days after TBI and was compared with healthy age-matched controls.

The direct and indirect effects of clinical empathy on well-being among pre-medical students: a structural equation model approach.

Background: Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.

Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting.

Context: Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place.

Methods: The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form.

Author Correction: Rapidly-migrating and internally-generated knickpoints can control submarine channel evolution.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Understanding Hospice Patients' Beliefs About Their Life Expectancy: A Qualitative Interview Study.

Background: Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making.

Objective: To examine the nature and source of hospice patients' life expectancy estimates, about which little is known.

Design: Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response.

Rapidly-migrating and internally-generated knickpoints can control submarine channel evolution.

Submarine channels are the primary conduits for terrestrial sediment, organic carbon, and pollutant transport to the deep sea. Submarine channels are far more difficult to monitor than rivers, and thus less well understood. Here we present 9 years of time-lapse mapping of an active submarine channel along its full length in Bute Inlet, Canada.

Direct Monitoring Reveals Initiation of Turbidity Currents From Extremely Dilute River Plumes.

Rivers (on land) and turbidity currents (in the ocean) are the most important sediment transport processes on Earth. Yet how rivers generate turbidity currents as they enter the coastal ocean remains poorly understood. The current paradigm, based on laboratory experiments, is that turbidity currents are triggered when river plumes exceed a threshold sediment concentration of ~1 kg/m.

Report on the CCT Supplementary comparison S2 on thermal conductivity measurements of insulating materials by guarded hot plate.

Seven National Metrology Institutes (NMIs) from France, United States, United Kingdom, Russia, Mexico, China and Germany participated in an inter-laboratory comparison on thermal conductivity measurements by the Guarded Hot Plate method. This action was part of a series of supplementary inter-laboratory comparisons (including infrared spectral emittance and thermal diffusivity) sponsored by the Consultative Committee on Thermometry (CCT) Task Group on Thermophysical Quantities (TG-ThQ). The objective of this collaborative work was to strengthen the consistency of thermal conductivity measurements carried out worldwide on low conductive materials.

Developing degraders: principles and perspectives on design and chemical space.

Degraders ( PROTACs, SNIPERs, degronimers ) are a new modality offering increasing potential both as tools for basic research and therapeutic development. They occupy chemical space that lies outside the classical Lipinski 'Rule of 5', which poses fresh challenges for achieving cell permeability and oral bioavailability. This study presents a comprehensive database of degrader structures from the peer reviewed literature, including both optimized degraders and first generation compounds, in order to provide a thorough assessment of the chemical space associated with this modality and identify common trends used during the 'hit to lead' process.

Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.

Purpose: The purpose of this study was to provide guidance on quality management for electronic brachytherapy.

Materials And Methods: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation.

Revisiting 'awareness contexts' in the 21st century hospital: How fragmented and specialized care shape patients' Awareness of Dying.

In 1965, Glaser and Strauss (1965) offered the concept of "awareness contexts" to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed (where patients are completely unaware and family and providers protect "the secret") to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al.

Understanding the impact of pelvic organ motion on dose delivered to target volumes during IMRT for cervical cancer.

Background: Advanced radiotherapy techniques reduce normal tissue dose by conforming closely to target volumes. In cervical cancer radiotherapy, organ filling affects clinical target volume (CTV; cervix, uterus) position. This study estimates the dosimetric effect of this primary CTV position variation during chemoradiation.