A new energy spectrum reconstruction method for time-of-flight diagnostics of high-energy laser-driven protons

The Time-of-Flight (TOF) technique coupled with semiconductorlike detectors, as silicon carbide and diamond, is one of the most promising diagnostic methods for high-energy, high repetition rate, laser-accelerated ions allowing a full on-line beam spectral characterization. A new analysis method for reconstructing the energy spectrum of high-energy laser-driven ion beams from TOF signals is hereby presented and discussed. The proposed method takes into account the detector's working principle, through the accurate calculation of the energy loss in the detector active layer, using Monte Carlo simulations. The analysis method was validated against well-established diagnostics, such as the Thomson parabola spectrometer, during an experimental campaign carried out at the Rutherford Appleton Laboratory (UK) with the high-energy laser-driven protons accelerated by the VULCAN Petawatt laser.

Digit Span Forward as a Performance Validity Test in Dementia Evaluations: Specificity in Mild Cognitive Impairment, Mild Dementia, and Moderate Dementia

Objective

Traditional performance validity tests (PVTs) often yield high false positive rates in dementia evaluations. The current study examined the frequency of extremely low scores (≤ 2 percentile) on WAIS-IV Digit Span Forward (DSF) in older adults with Mild Cognitive Impairment (MCI) or dementia to evaluate its possible utility as a PVT in these populations.

Method

Archival data from outpatient neuropsychological evaluations were analyzed. Individuals who were not diagnosed with a neurocognitive disorder, had missing data, or were believed to be invalidly performing were excluded. Participants (n = 195; mean age = 72.8; mean education = 13.2 years) were classified according to their evaluation diagnosis of MCI (n = 72; mean RBANS Total Score = 86.8) or dementia. Dementia patients were further divided by MoCA score into groups of mild dementia (n = 90; MoCA≥15; mean RBANS Total Score = 71.0) or moderate dementia (n = 33; MoCA < 15; mean RBANS Total Score = 55.9). Frequencies of scaled scores were analyzed to calculate specificity values for each group.

Results

A WAIS-IV DSF scaled score of ≤4 (≤ 2 percentile) resulted in specificity values of 0.99 and 0.94 in MCI and mild dementia, respectively. Conversely, in moderate dementia, ≥0.90 specificity was achieved only when using a more conservative cutoff of ≤2.

Conclusions

Low DSF scaled scores occurred infrequently in MCI and mild dementia, indicating strong specificity and potential utility as a PVT in these populations. However, in moderate dementia, low DSF scores were more common, requiring use of a more stringent cutoff. Future research should examine DSF sensitivity to invalid performance, as well as DSF specificity according to specific etiologies of MCI and dementia.

Use of inline near-infrared spectroscopy to predict the viscosity of shampoo using multivariate analysis

Objective

In the personal care industry, viscosity is a critical quality attribute that influences product quality and process economics. Like many industrial liquids, personal care liquids are complex non‐Newtonian liquids made up of aqueous surfactant systems whose viscosity depends on the build‐up of micellar networks. Measuring the viscosity of complex liquids offline is easily done using benchtop rheometers and viscometers. The challenge lies in measuring the viscosity of personal care liquids online during manufacturing. Being able to track the viscosity of such products through their manufacturing cycle will not only allow for better process control but also more enhanced quality control. Therefore, the aim of this work was to investigate how proxy measurements using inline near‐infrared (NIR) spectroscopy in transmission mode can be used to predict the viscosity of shampoo. NIR spectroscopy has not, to the best our knowledge, been used to predict the viscosity of complex surfactant systems like shampoo and could significantly affect the way quality is monitored in a manufacturing environment.

Method

This work focuses on viscosity changes because of differences in chloride content as salt is often used to adjust viscosity. The relationship between salt content and the viscosity of shampoo is well known following the salt curve. From an industrial perspective the region of interest for the formulation studied in this work only covers a small section of this curve. Therefore, two predictive models were developed: one covering the full range of the salt curve and another focusing on the industrially applicable region.

Result

Models were produced using partial least squares (PLS) where both datasets showed some predictive ability with the concentrated region of interest showing enhanced performance [root mean square error of prediction (RMSEP) – 2.32 Pa s] compared with the larger range (RMSEP – 4.44 Pa s).

Conclusion

This work provides a good starting point for developing robust predictive models for in situ viscosity measurements for shampoo manufacturing, where further work into different sources of variation and the extent of the modelling capability with regards to different formulations should be studied.

Outcomes of melanoma patients with brain metastases receiving immune checkpoint inhibitor (ICI) therapy

e21028

Background: The effect of ICI therapy on brain metastasis (mets) in melanoma patients has been described, however the impact of genomic alterations and local treatment (trt) including radiation therapy (RT) on CNS outcomes and overall survival (OS) has not yet been explored. Methods: Under institutional IRB approval, we reviewed our electronic medical record to identify patients (pts) with metastatic melanoma and brain mets who received trt with ICI. Trt history, CNS responses as indicated by the treating physician and available genomic data were recorded. OS was estimated using a multivariable Cox regression model adjusting for genomic alteration, age, ICI regimen and brain mets. Results: A total of 49 pts were identified (65% male). Thirty seven pts had testing for tumor genomic alterations (alt, hotspot and comprehensive genomic testing); BRAFV600E( 30%), cKIT(5%), NRAS(16%), no alt (38%). Prior to initiation of ICI, 78% had known CNS mets, of these, 61% received RT. There was no difference in median OS for pts who started RT prior to ICI compared to those without RT (mOS = 75.71 vs 49.4 weeks, p = 0.75). Median OS was improved for those pts who received RT > 90 days prior to initiation of ICI trt however this was not statistically significant (45.7 vs 136 weeks, p = 0.12) and HR = 0.45 (95% CI 0.08, 2.36). OS was not significantly different in pts with genomic alterations compared with those without alterations (p = 0.264). Of the pts with known brain mets at the time of ICI start, 34% had progressive disease at 3 months and 11% were felt to have pseudoprogression. 18% survived to undergo 6-month disease assessment, of these 12% had further progression. All pts with cKIT mutations survived to 6-month disease assessment. 75% of pts with known brain mets developed new lesions, 15% had increased mass size. Pts who developed new brain mets while on trt with ICI had worse survival than those with preexisting brain mets and developed new brain lesions (28 vs 58 weeks, p = 0.05). 6% of all pts developed CNS immune related adverse effects. Conclusions: Most patients with melanoma and known brain metastasis prior to ICI developed new brain lesions as a site of metastatic spread. The development of new brain mets was associated with worse outcomes. Neither genomic alterations nor RT prior to ICI start were associated with improved survival.

Treatment approaches and survival outcomes of older patients with locally advanced esophageal cancer (LAEC) in Ireland

e23034

Background: Neo+/- adjuvant treatment data in older patients with cancer is sparse due to exclusion of this population from clinical trials. We evaluated the management of locally advanced esophagogastric cancer (LAEC) in older Irish patients to determine treatment modalities utilized and identify factors associated with survival. Methods: Patients diagnosed with LAEC (stage II or III) over a 5 year period (2007-2011)were identified from the National Cancer Registry of Ireland. Follow-up was till end 2014.Demographic characteristicswere assessed. Treatment was classified as “best supportive care (BSC)”, “surgery only”, “neo/adjuvant treatment” and “chemo/radiation alone” (ie chemo, radiotherapy or chemoradiotherapy alone in the absence of surgery).Survival was estimated by Kaplan-Meier estimates and Cox models. Clinicopathologic factors and treatment type found to be significant in univariate analysis were included in a multivariate analysis (MVA). Results: 46%(n = 580) of the 1,251 patients were ≥70yrs, 62% had stage III disease and 51% had gastric cancer. 11% (n = 134) received BSC, 23% (n = 288) had surgery only, 31%(n = 390) had chemo/radiation alone, 35% (n = 439) had neo/adjuvant treatment. 20% (n = 39) of patients ≥75yrs had neoadjuvant treatment compared to 46% < 75 yrs. No patient ≥80yrs received neo/adjuvant treatment. With increasing age patients were less likely to receive neo/adjuvant treatment (p < 0.001), less likely to receive surgery (p < 0.001) and less likely to receive any treatment (p < 0.001).Median survival(OS) decreased with age (< 70yrs: 23months; 70-74: 19months; 75-79:13months; ≥80 years:10 months). In MVA, older age, smoking, later stage, higher grade were significantly associated with a higher risk of death.Including an interaction between treatment and age, patients receiving adjuvant or neoadjuvant treatment had lower risk of death than any other treatment group regardless of age. Conclusions: Older patients were less likely to receive any treatment for LAEC than younger patients. Patients ≥70 years benefit from neo/adjuvant treatment, however,these patients are often excluded based on age. Prospective clinical trials focusing on elderly patients and incorporating life expectancy, comorbidities and geriatric assessment are needed to best guide treatment.

Association between surgeon special interest and mortality after emergency laparotomy

Background

Approximately 30 000 emergency laparotomies are performed each year in England and Wales. Patients with pathology of the gastrointestinal tract requiring emergency laparotomy are managed by general surgeons with an elective special interest focused on either the upper or lower gastrointestinal tract. This study investigated the impact of special interest on mortality after emergency laparotomy.

Methods

Adult patients having emergency laparotomy with either colorectal or gastroduodenal pathology were identified from the National Emergency Laparotomy Audit database and grouped according to operative procedure. Outcomes included all-cause 30-day mortality, length of hospital stay and return to theatre. Logistic and Poisson regression were used to analyse the association between consultant special interest and the three outcomes.

Results

A total of 33 819 patients (28 546 colorectal, 5273 upper gastrointestinal (UGI)) were included. Patients who had colorectal procedures performed by a consultant without a special interest in colorectal surgery had an increased adjusted 30-day mortality risk (odds ratio (OR) 1·23, 95 per cent c.i. 1·13 to 1·33). Return to theatre also increased in this group (OR 1·13, 1·05 to 1·20). UGI procedures performed by non-UGI special interest surgeons carried an increased adjusted risk of 30-day mortality (OR 1·24, 1·02 to 1·53). The risk of return to theatre was not increased (OR 0·89, 0·70 to 1·12).

Conclusion

Emergency laparotomy performed by a surgeon whose special interest is not in the area of the pathology carries an increased risk of death at 30 days. This finding potentially has significant implications for emergency service configuration, training and workforce provision, and should stimulate discussion among all stakeholders.

Alteration of facial growth after radiotherapy: orthodontic, surgical and prosthetic rehabilitation

Most patients treated in childhood with radiotherapy for head and neck tumors develop craniofacial alterations related to impaired growth of the irradiated regions. These deformities have a significant functional and aesthetic impact, generating physiological and social troubles. The therapeutic solutions are mostly surgical and multidisciplinary. In this article, we describe the orthodontic and surgical care of a teenager treated with radiotherapy for a bilateral retinoblastoma at the age of 8 month and a half. The patient presented growth defects of the middle third of the face. These growth deficiencies are at the origin of significant aesthetic and physical disorders. Moreover, the three-dimensional skeletal abnormalities and the histological changes of these irradiated tissues make surgical management of the cases complex and specific.

Genome-wide association study for αS1- and αS2-casein phosphorylation in Dutch Holstein Friesian

Phosphorylation of caseins (CN) is a crucial post-translational modification that allows caseins to form colloid particles known as casein micelles. Both α_S1- and α_S2-CN show varying degrees of phosphorylation (isoforms) in cow milk and were suggested to be more relevant for stabilizing internal micellar structure than β- and κ-CN. However, little is known about the genetic background of individual α_S2-CN phosphorylation isoforms and the phosphorylation degrees of α_S1- and α_S2-CN (α_S1-CN PD and α_S2-CN PD), defined as the proportion of isoforms with higher degrees of phosphorylation in total α_S1- and α_S2-CN, respectively. We aimed to identify genomic regions associated with these traits using 50K single nucleotide polymorphisms for 1,857 Dutch Holstein Friesian cows. A total of 10 quantitative trait loci (QTL) regions were identified for all studied traits on 10 Bos taurus autosomes (BTA1, 2, 6, 9, 11, 14, 15, 18, 24, and 28). Regions associated with multiple traits were found on BTA1, 6, 11, and 14. We showed 2 QTL regions on BTA1, one affecting α_S2-CN production and the other harboring the SLC37A1 gene, which encodes a phosphorus antiporter and affects α_S1- and α_S2-CN PD. The QTL on BTA6 harbors the casein gene cluster and affects individual α_S2-CN phosphorylation isoforms. The QTL on BTA11 harbors the PAEP gene that encodes for β-lactoglobulin and affects relative concentrations of α_S2-CN-10P and α_S2-CN-11P as well as α_S1-CN PD and α_S2-CN PD. The QTL on BTA14 harbors the DGAT1 gene and affects relative concentrations of α_S2-CN-10P and α_S2-CN-11P as well as α_S1-CN PD and α_S2-CN PD. Our results suggest that effects of identified genomic regions on phosphorylation of α_S1- and α_S2-CN are related to changes in milk synthesis and phosphorus secretion in milk. The actual roles of SLC37A1, PAEP, and DGAT1 in α_S1- and α_S2-CN phosphorylation in Dutch Holstein Friesian require further investigation.