Reduction of occupational radiation dose in staff at the cardiac catheterisation laboratory by protective material placed on the patient

Reducing occupational radiation dose in cardiac catheterisation laboratories is one of the objectives of the radiation protection system because the procedures performed involve high levels of radiation compared with others in health care. Recommendations on protection methods used are referred to different structural types and personal protection tools. In this work, the effectiveness of a shielding drape above the patient in different geometric shapes for a standard procedure in interventional cardiology was evaluated. Values of personal dose equivalent Hp(10) obtained simultaneously with three active electronic semiconductor dosemeters located at the usual position of staff and at the C-arm have been used to show the usefulness of the shielding drape.

On the scattered light by dilute aqueous dispersions of nanogel particles

This work deals with the scattered light by nanoparticles formed by a temperature sensitive polymer networks, namely nanogel particles. The scattered light is measured as a function of the scattering angle at temperatures below and above the volume phase transition temperature (VPTT) of nanogel particles. Our experimental results indicate that nanogel particles have a core-shell structure, formed by a uniform highly cross-linked core surrounded by a fuzzy shell where the polymer density decays to zero gradually for swollen configurations and sharply for shrunken states. The theoretical fitting of the experimental curves shows that the scattered light at low angle obeys a decreasing power law with the scattering vector, q(-α). The value of exponent α provides information about the radial dependence of the polymer density at the external shell of the particles for swollen nanogels, and about the degree of roughness of the surface for the case of shrunken nanogels. On the one hand, at low temperatures (below the VPPT), the nanogel particle is in the swollen state and the light scattering data show that its shell structure follows a fractal behaviour, with a polymer density that decays as r(α-3), where r is the distance to the particle centre. On the other hand, above the VPPT the results indicate that nanogel collapses into a core of uniform polymer density and a rough shell, with a fractal surface dimension of 2.5.

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

AIM

to evaluate the effects of a 12--weeks combined aerobic--resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health--related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients.

METHODS

a randomized controlled trial design was employed. Forty--three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic--resistance exercise for 12--weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12--weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF--36 questionnaire.

RESULTS

the exercise therapy led to improvements in muscle fatigue in knee extensors (--55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (--18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%).

CONCLUSION

12--weeks of combined aerobic--resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management

Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.

Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach

An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.

An outbreak of respiratory syncytial virus infection in hematopoietic stem cell transplantation outpatients: good outcome without specific antiviral treatment

BACKGROUND

Respiratory syncytial virus (RSV) is a common cause of seasonal respiratory viral infection in hematopoietic stem cell transplantations (HSCT) patients. The efficacy of treatment, however, remains controversial. We describe an outbreak of 31 cases of RSV that occurred in an HSCT outpatient care unit in the fall season from March through May 2010, with a good outcome without any specific antiviral treatment.

METHODS

During these 3 months, 222 nasal wash samples were tested and, of these, 31 outpatients were positive for RSV. In 2009, 99 samples had been tested and only 10 outpatients were positive for RSV in the same period.

RESULTS

Seven (22.5%) patients had severe neutropenia (<500 cells/μL); severe lymphopenia (<200 cells/μL) was present in 13 (41.9%) patients, and 14 (45%) had received intravenous broad-spectrum antibiotics. Hospitalization was necessary only for 8 patients (25.8%); 20 had lower respiratory tract infection (64.5%). Only 1 patient died as a result of proven invasive aspergillosis.

CONCLUSION

This report suggests that HSCT outpatients with no risk factors may not always require specific treatment for RSV.

The initial phase for validating the European algorithm for functional assessment prior to lung resection: quantifying compliance with the recommendations in actual clinical practice

OBJECTIVE

To quantify the degree of compliance with the recommendations of the clinical practice guidelines published in 2009 by the ERS and the ESTS regarding the preoperative assessment of risk of lung resection in daily clinical practice at a tertiary hospital.

METHOD

A prospective, observational study of real-time data collected from consecutive patients who had been referred for evaluation from September 2009 to December 2010. We recorded the presence or absence of the recommended studies included in the algorithm, their results and, when a test was missing, the reasons why it was not performed. Hospital mortality and cardio-respiratory morbidity rates are also presented.

RESULTS

173 patients were evaluated. In 171 cases, lung resection was performed, with a mortality of 1.2% and a cardio-respiratory morbidity of 11.7%. The failure rate of the first level of the algorithm was 4.6% and for the second level (VO(2max) test) it was 26%. The absence of exercise tests was mainly due to hospital structural problems and the patients' inability to perform it. Out of the patients who performed the exercise testing, 31 reached a VO(2max) of 20 ml/kg-min or more and underwent surgery without calculation of FEV(1)ppo and DCLOppo; 35 patients required the calculation to determine their operability and in 2 cases the intervention was not recommended due to functional inoperability of the patient.

CONCLUSIONS

The validation process found lack of compliance with the proposed algorithm in 18.5% of the cases basically due to the absence of the exercise tests. The rate of adherence to the algorithm recommendations should be improved before performing any other validation studies.