Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Activity measurements and determination of nuclear decay data of 166Ho in the MRTDosimetry project

Holmium-166 is a high-energy β^--emitter radionuclide (~ 1.8 MeV) with a short half-life (~26.8h) that offers great potential as an alternative to ⁹⁰Y for the treatment of liver cancer based on radioembolization. The possibility of quantitative Single Photon Emission Computed Tomography (SPECT) imaging of the main γ-ray emission at 80.6 keV, in addition to strong paramagnetic properties suitable for Magnetic Resonance Imaging (MRI), complement this therapeutic potential. The present paper describes the measurements carried out in three European radionuclide metrology laboratories for primary standardization of ¹⁶⁶Ho and new determinations of X- and γ-ray photon-emission intensities in the framework of the European EMPIR project MRTDosimetry. New half-life measurements were also performed.

Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

Aims

Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.

Methods

MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.

Stakeholders

Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors.

Results

MASK is deployed in 23 countries and 17 languages. 26,000 users have registered.

EU grants (2018)

MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).

Lessons learnt

(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

Standardization of 68Ge/68Ga using the 4πβ-γ coincidence method based on Cherenkov counting

In the framework of an international BIPM comparison (Bureau International des Poids et Mesures), the activity standardization of ⁶⁸Ge in a solution of ⁶⁸Ge/⁶⁸Ga in equilibrium provided by NIST was carried out at LNHB. This exercise was organized to meet the growing interest in ⁶⁸Ga as a radiopharmaceutical in nuclear medicine services (e.g. as a surrogate of ¹⁸F for PET imaging). Due to the volatility of germanium, the activity standardization of ⁶⁸Ge was investigated at LNHB by means of 4πβ-γ coincidence counting based on Cherenkov measurements. This technique was applied to take advantage of the Cherenkov threshold (~ 260keV in aqueous solutions) in order to prevent counting from electron-capture events associated with ⁶⁸Ge disintegrations. Cherenkov counting was performed using glass and polyethylene vials and the resulting activity concentrations were compared with 4πβ-γ coincidence measurements based on liquid scintillation. The efficiency-extrapolation curve obtained with Cherenkov measurements in glass vials was compared to Monte Carlo simulations based on the Geant4 code.

CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report

A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.

Work productivity in rhinitis using cell phones: The MASK pilot study

Allergic rhinitis often impairs social life and performance. The aim of this cross-sectional study was to use cell phone data to assess the impact on work productivity of uncontrolled rhinitis assessed by visual analogue scale (VAS). A mobile phone app (Allergy Diary, Google Play Store and Apple App Store) collects data from daily visual analogue scales (VAS) for overall allergic symptoms (VAS-global measured), nasal (VAS-nasal), ocular (VAS-ocular) and asthma symptoms (VAS-asthma) as well as work (VAS-work). A combined nasal-ocular score is calculated. The Allergy Diary is available in 21 countries. The app includes the Work Productivity and Activity Impairment Allergic Specific Questionnaire (WPAI:AS) in six EU countries. All consecutive users who completed the VAS-work from 1 June to 31 October 2016 were included in the study. A total of 1136 users filled in 5818 days of VAS-work. Symptoms of allergic rhinitis were controlled (VAS-global <20) in approximately 60% of the days. In users with uncontrolled rhinitis, approximately 90% had some work impairment and over 50% had severe work impairment (VAS-work >50). There was a significant correlation between VAS-global calculated and VAS-work (Rho=0.83, P<0.00001, Spearman's rank test). In 144 users, there was a significant correlation between VAS-work and WPAI:AS (Rho=0.53, P<0.0001). This pilot study provides not only proof-of-concept data on the work impairment collected with the app but also data on the app itself, especially the distribution of responses for the VAS. This supports the interpretation that persons with rhinitis report both the presence and the absence of symptoms.

Grafting well-defined CO2-responsive polymers to cellulose nanocrystals via nitroxide-mediated polymerisation: effect of graft density and molecular weight on dispersion behaviour

Tertiary polyamines and polyamides were grafted to cellulose nanocrystals (CNC) via Nitroxide-Mediated Polymerisation to yield well-defined CNC, which were examined for their CO₂-responsive dispersibility in water and oil.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Drug usage patterns and treatment costs in newly-diagnosed type 2 diabetes mellitus cases, 2007 vs 2012: findings from a large US healthcare claims database analysis

Objective To explore trends in demographics, comorbidities, anti-diabetic drug usage, and healthcare utilization costs in patients with newly-diagnosed type 2 diabetes mellitus (T2DM) using a large US claims database. Methods For the years 2007 and 2012, Truven Health Marketscan Research Databases were used to identify adults with newly-diagnosed T2DM and continuous 12-month enrollment with prescription benefits. Variables examined included patient demographics, comorbidities, inpatient utilization patterns, healthcare costs (inpatient and outpatient), drug costs, and diabetes drug claim patterns. Results Despite an increase in the overall database population between 2007-2012, the incidence of newly-diagnosed T2DM decreased from 1.1% (2007) to 0.65% (2012). Hyperlipidemia and hypertension were the most common comorbidities and increased in prevalence from 2007 to 2012. In 2007, 48.3% of newly-diagnosed T2DM patients had no claims for diabetes medications, compared with 36.2% of patients in 2012. The use of a single oral anti-diabetic drug (OAD) was the most common diabetes medication-related claim (46.2% of patients in 2007; 56.7% of patients in 2012). Among OAD monotherapy users, metformin was the most commonly used and increased from 2007 (74.7% of OAD monotherapy users) to 2012 (90.8%). Decreases were observed for sulfonylureas (14.1% to 6.2%) and thiazolidinediones (7.3% to 0.6%). Insulin, predominantly basal insulin, was used by 3.9% of patients in 2007 and 5.3% of patients in 2012. Mean total annual healthcare costs increased from $13,744 in 2007 to $15,175 in 2012, driven largely by outpatient services, although costs in all individual categories of healthcare services (inpatient and outpatient) increased. Conversely, total drug costs per patient were lower in 2012 compared with 2007. Conclusions Despite a drop in the rate of newly-diagnosed T2DM from 2007 to 2012 in the US, increased total medical costs and comorbidities per individual patient suggest that the clinical and economic trends for T2DM are not declining.

Calculation of extrapolation curves in the 4π(LS)β-γ coincidence technique with the Monte Carlo code Geant4

At LNE-LNHB, a liquid scintillation (LS) detection setup designed for Triple to Double Coincidence Ratio (TDCR) measurements is also used in the β-channel of a 4π(LS)β-γ coincidence system. This LS counter based on 3 photomultipliers was first modeled using the Monte Carlo code Geant4 to enable the simulation of optical photons produced by scintillation and Cerenkov effects. This stochastic modeling was especially designed for the calculation of double and triple coincidences between photomultipliers in TDCR measurements. In the present paper, this TDCR-Geant4 model is extended to 4π(LS)β-γ coincidence counting to enable the simulation of the efficiency-extrapolation technique by the addition of a γ-channel. This simulation tool aims at the prediction of systematic biases in activity determination due to eventual non-linearity of efficiency-extrapolation curves. First results are described in the case of the standardization (59)Fe. The variation of the γ-efficiency in the β-channel due to the Cerenkov emission is investigated in the case of the activity measurements of (54)Mn. The problem of the non-linearity between β-efficiencies is featured in the case of the efficiency tracing technique for the activity measurements of (14)C using (60)Co as a tracer.

Improved real-world glycaemic outcomes with liraglutide versus other incretin-based therapies in type 2 diabetes

AIM

Liraglutide (LIRA) once-daily has provided greater A1C reductions than either exenatide (EXEN) twice-daily or sitagliptin (SITA) once-daily in head-to-head trials. The objective of this analysis is to compare the real-world clinical effectiveness of these agents in the USA.

METHODS

Using the IMS Health (Alexandria, VA, USA) integrated claims database, A1C outcomes in patients aged ≥ 18 years with type 2 diabetes (T2D) who initiated either LIRA, EXEN or SITA (including SITA/metformin) were retrospectively compared. Patients included in the analysis had ≥ 1 prescription for LIRA, EXEN or SITA between January and December 2010 (index period) and persisted with their index treatment regimens for 6 months post-index. Outcomes included changes in A1C from baseline (45 days pre-index through 7 days post-index) to follow-up [6 months post-index (± 45)] and the proportion of patients reaching A1C<7%. Multivariable regression models adjusted for confounding factors (e.g. age, comorbidities, baseline A1C and background antidiabetic therapy).

RESULTS

The predicted change in A1C from baseline was greater for LIRA patients compared with both SITA (-1.08 vs. -0.68%; treatment difference 0.40%, p < 0.0001) and EXEN (-1.08 vs. -0.75%; treatment difference 0.32%, p < 0.001). Predicted A1C goal achievement, derived from the multivariate logistic regression model, was higher with LIRA compared with both SITA [64.4% (95% confidence interval, CI: 63.5-65.3) vs. 49.4% (95% CI: 48.5-50.4); p < 0.0001] and EXEN [64.4% (95% CI: 63.5-65.3) vs. 53.6% (95% CI: 52.6-54.6); p < 0.0001].

CONCLUSIONS

In clinical practice, LIRA was associated with significantly greater reductions in A1C and improved glycaemic goal attainment compared with either EXEN or SITA among adult patients with T2D.

First TDCR measurements at low energies using a miniature x-ray tube

Developed for radionuclide standardization using liquid scintillation, the Triple to Double Coincidence Ratio (TDCR) method is applied using coincidence counting obtained with a specific three-photomultiplier system. For activity determination, a statistical model of light emission is classically used to establish a relation between the detection efficiency and the experimental TDCR value. At LNE-LNHB, a stochastic approach of the TDCR modeling was developed using the Monte Carlo code Geant4. The interest of this TDCR-Geant4 model is the possibility to simulate the propagation of optical photons from their creation in the scintillation vial to the production of photoelectrons in photomultipliers. As an alternative to the use of radionuclide sources, first TDCR measurements are presented using a miniature x-ray tube closely coupled to the scintillation vial. The objective of this new set-up was to enable low-energy depositions (lower than 20 keV) in liquid scintillator in order to study the influence of both time and geometrical dependence between PMTs already observed with radioactive sources. As for the statistical TDCR model, the non-linearity of light emission is implemented in the TDCR-Geant4 model using the Birks formula which depends on the kB factor and the scintillation yield. Measurements performed with the x-ray tube are extended to the assessment of these parameters and they are tested afterwards in the TDCR-Geant4 model for activity measurements of (3)H.

Digital pulse processing and optimization of the front-end electronics for nuclear instrumentation

This article describes an algorithm developed for the digital processing of signals provided by a high-efficiency well-type NaI(Tl) detector used to apply the 4πγ technique. In order to achieve a low-energy threshold, a new front-end electronics has been specifically designed to optimize the coupling to an analog-to-digital converter (14 bit, 125 MHz) connected to a digital development kit produced by Altera(®). The digital pulse processing is based on an IIR (Infinite Impulse Response) approximation of the Gaussian filter (and its derivatives) that can be applied to the real-time processing of digitized signals. Based on measurements obtained with the photon emissions generated by an (241)Am source, the energy threshold is estimated to be equal to ~2 keV corresponding to the physical threshold of the NaI(Tl) detector. An algorithm developed for a Silicon Drift Detector used for low-energy x-ray spectrometry is also described. In that case, the digital pulse processing is specifically designed for signals provided by a reset-type preamplifier ((55)Fe source).

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes

AIMS

This retrospective observational study examined the association between International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded outpatient hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes.

METHODS

Data were derived from healthcare claims for individuals with employer-sponsored Medicare supplemental insurance. The study period consisted of two consecutive 1-year periods; the baseline period (1 April 2008 to 31 March 2009) and the evaluation period (1 April 2009 to 31 March 2010). Patients selected for study were at least 65 years of age with evidence of type 2 diabetes during the baseline period, as identified using a Healthcare Effectiveness Data and Information Set algorithm or by at least two prescription claims for oral antidiabetic drugs. The baseline period was used to collect information on the patients' demographics and clinical characteristics. The evaluation period was used to identify the presence of hypoglycaemic events and fall-related fractures. Logistic regression was employed to examine the association between hypoglycaemic events and fall-related fractures occurring during the evaluation period, adjusting for patients' demographics and clinical characteristics.

RESULTS

Of 361 210 included patients, 16 936 had hypoglycaemic events during the evaluation period. Patients with hypoglycaemic events had 70% higher regression-adjusted odds (hypoglycaemic events odds ratio = 1.70; 95% confidence interval = 1.58-1.83) of fall-related fractures than patients without hypoglycaemic events. Multiple sensitivity analyses also yielded results suggesting increased odds of fall-related fractures in patients with hypoglycaemic events.

CONCLUSIONS

ICD-9-CM-coded outpatient hypoglycaemic events were independently associated with an increased risk of fall-related fractures. Further studies of the relationship between hypoglycaemia and the risk of fall-related fractures are warranted.

Development and implementation of guidelines in allergic rhinitis – an ARIA-GA2LEN paper

The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.

Degradation of Kraft Indulin Lignin by Streptomyces viridosporus and Streptomyces badius

Crawford and collaborators have studied extensively the solubilization of lignocellulose by two Streptomyces species, S. badius and S. viridosporus. Using a condensed industrial lignin essentially devoid of carbohydrates, Indulin AT, as the sole source of carbon, similar results were obtained: (i) the growths of the bacteria were optimum at pH 7.5 to 8.5; (ii) yeast extract was a better source of nitrogen than NH(4)Cl; (iii) the products of the depolymerization of Indulin were soluble, acid-precipitable polymers. When d-glucose was added as a secondary carbon source, it was used preferentially and the production of acid-precipitable polymers began only after the complete depletion of the sugar. On the assumption that the degradation of Indulin was catalyzed by enzymes, proteins found in the culture media and soluble and insoluble intracellular proteins were incubated with Indulin at pH 7.0 at 37 degrees C. Proteins in all fractions from S. badius had ligninolytic activities which, with the exception of those in the intracellular soluble fraction, were increased in the presence of H(2)O(2). In S. viridosporus, both extra- and intracellular soluble activities were found which were not increased by H(2)O(2). The extracellular activity of S. viridosporus was not affected by heat, resisted partially an exposure to pH 1.0, and was completely destroyed by proteolysis.

DUPLICATE: Digital instrumentation and management of dead time: First results on a NaI well-type detector setup

The Publisher regrets that this article is an accidental duplication of an article that has already been published, doi:10.1016/j.apradiso.2010.01.040. The duplicate article has therefore been withdrawn.

Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting

BACKGROUND

Insulin is a mainstay in the treatment of type 1 diabetes and is a recommended option in patients with type 2 diabetes who fail to maintain glycaemic control on other non-insulin therapies. The purpose of this study was to describe patient characteristics and evaluate changes in glycaemic control and weight in patients treated with insulin in an ambulatory care setting.

METHODS

Patients with diabetes were identified from the General Electric electronic medical record (EMR) database (1 September 2004 to 30 April 2008). Patients were > or =18 years, insulin naive, newly treated with monoinsulin therapy (index date). Baseline characteristics were identified overall and stratified by insulin type (basal, mixed, and rapid). Basal insulins were described by human versus analog and for insulin detemir and insulin glargine. Change in haemoglobin A1C (HbA1C) and weight from baseline (45 days pre- to 15 days postindex date) to 6 months (+/-90 days) were compared. Regression analyses were used to evaluate HbA1C outcomes across insulins and for the likelihood of gaining 0.9 kg (2 lbs) for detemir versus glargine controlling for baseline characteristics.

RESULTS

A total of 12 136 patients were included. A majority were initiated on a basal insulin (64.7%) followed by mixed (20.8%) and rapid (14.4%). Basal users had significantly higher mean body weight and lower mean baseline HbA1C than mixed users (p < 0.001 for all), and were significantly older, had higher baseline HbA1C and higher baseline body mass index (BMI) than rapid insulin users (p < 0.001 for all). Glargine patients had a significantly higher mean baseline HbA1C (p = 0.003) than detemir patients. The adjusted reduction in HbA1C was greater for rapid insulin than for mixed or basal insulin (p < or = 0.05). The adjusted differences in HbA1C between basal human and basal analog insulins and between detemir and glargine were not statistically significant (p > 0.05). Patients using detemir were 30% less likely to gain 0.9 kg or more than glargine users (p < 0.05).

CONCLUSIONS

HbA1C outcomes in the ambulatory care setting were generally not different between insulin classes. The likelihood of weight gain was less with insulin detemir than with insulin glargine. Thus, real-world weight outcomes for basal analog insulin may differ by specific product.

Renal replacement therapy for acute renal failure

Renal replacement therapy became a common clinical tool to treat patients with severe acute kidney injury (AKI) since the 1960s. During this time dialytic options have expanded considerably; biocompatible membranes, bicarbonate dialysate and dialysis machines with volumetric ultrafiltration control have improved the treatment for acute kidney injury. Along with advances in methods of intermittent hemodialysis, continuous renal replacement therapies have gained widespread acceptance in the treatment of dialysis-requiring AKI. However, many of the fundamental aspects of the renal replacement treatment such as indication, timing of dialytic intervention, and choice of dialysis modality are still controversial and may influence AKI patient's outcomes. This review outlines current concepts in the use of dialysis techniques for AKI and suggests an approach for selecting the optimal method of renal replacement therapy.

Validation study of a new technique for absolute activity measurement with 4pi solid angle metallic magnetic calorimeters

In this paper we present a prototype of a new class of detectors, metallic magnetic calorimeters operating at cryogenic temperatures, which we are developing for absolute activity measurement of low-energy-emitting radionuclides. We explain the detection principle and give a detailed description of the realisation of the prototype, containing an (55)Fe source inside the detector absorber. The analysis of first data taken with this detector is presented and the result of activity measurement compared with liquid scintillation counting. Some ways for reducing the uncertainty that can be achieved with this new technique are proposed.

Acid-base disturbances in the intensive care unit: current issues and the use of continuous renal replacement therapy as a customized treatment tool

Continuous renal replacement therapies (CRRT) are often used to manage complex acid-base problems in critically ill patients. These techniques allow a constant manipulation of the plasma composition. Several technical factors from CRRT influence the acid-base status; namely, the effluent rate, the operational characteristics of the technique, the content of the solutions and the metabolic rate of the buffer. This article reviews the common acid base disorders occurring in the intensive care unit, using both the anion gap and the strong ion gap approaches, and describes the influence of CRRT on acid-base physiology. The use of CRRT as a customized therapy for acid-base disorders is discussed, allowing an integration of both physiological and technical concepts.

Standardization of 67Ga using a 4π(LS)β–γ anti-coincidence system

(67)Ga is an interesting radionuclide as it is widely used in nuclear medicine. The meta-stable level related to the 93.3keV gamma-transition represents the main difficulty when using the coincidence method to standardize this radionuclide. The 4pi(LS)beta-gamma anti-coincidence system implemented at LNHB is based on the use of electronic modules specifically designed for radioactivity metrology. On the contrary to classical coincidence systems, activity measurements of (67)Ga are carried out as for prompt beta-gamma emitters; indeed, when using a live-timed anti-coincidence system with extendable dead times, the problem due to the excess of counting generated by the meta-stable level is avoided. Considering that the standardization of (67)Ga does not depend on the decay scheme parameters (except for the half-life), the measurement of the gamma-emission intensities has been performed. The standardization of this radionuclide was also a good opportunity for a new participation of our laboratory in the SIR of (67)Ga (International Reference System); the result obtained with the 4pi(LS)beta-gamma anti-coincidence system is compared with those submitted by other National Metrology Institutes (NMIs). The non-extendable dead times used in most of the participations could be one of the causes responsible for the abnormal dispersion of the results. The optimization of the standard solution of (67)Ga for the radioactive source preparation is also discussed.

High-energy resolution alpha spectrometry using cryogenic detectors

Applications such as environment monitoring implying alpha emitters activity measurement associated with isotope identification, require high-energy resolution detectors. Conventional silicon detectors are inexpensive therefore widely used, although intrinsically limited in energy resolution. Thermal detection principle of cryogenic detectors introduces a breakthrough in alpha particle measurement. For the first time, spectra with 5.5 keV FWHM energy resolution have been obtained for several external alpha emitting sources using a copper-germanium bolometer specially developed for alpha spectrometry.

Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN)

The pharmacologic treatment of allergic rhinitis proposed by ARIA is an evidence-based and step-wise approach based on the classification of the symptoms. The ARIA workshop, held in December 1999, published a report in 2001 and new information has subsequently been published. The initial ARIA document lacked some important information on several issues. This document updates the ARIA sections on the pharmacologic and anti-IgE treatments of allergic rhinitis. Literature published between January 2000 and December 2004 has been included. Only a few studies assessing nasal and non-nasal symptoms are presented as these will be discussed in a separate document.

A 4pi(LS)beta-gamma coincidence system using a TDCR apparatus in the beta-channel

This article is an overview of the capabilities of a 4 pi(LS)beta-gamma coincidence counting system based on a liquid scintillation detector in the beta-channel. Equipped with a three-photomultiplier apparatus designed for the triple to double coincidence ratio (TDCR) method, the 4 pi(LS)beta-gamma coincidence system developed at LNHB combines the two techniques. The 4 pi(LS)beta-gamma counting setup records the different types of scintillation events between photomultipliers (double and triple coincidences) and the associated gamma-spectra according to a bi-dimensional configuration. When measuring the activity of a (54)Mn solution, the extrapolation method is carried out by defocusing the photomultipliers; this procedure allows the measurement of gamma-ray sensitivity of the scintillation cocktail in the 835 keV energy region. In addition, in the framework of a (65)Zn standardization, 4 pi(LS)beta-gamma measurements are compared with standard 4 pi(PC)beta-gamma anticoincidence counting using a proportional counter in the beta-channel.

Freeze-drying applied to radioactive source preparation

In the framework of R&D studies for the improvement of radioactive source efficiencies prepared on thin films for 4pibeta-gamma coincidence counting, a comparative study on two drying methods has been undertaken in our laboratory (BNM-Laboratoire National Henri Becquerel, France). The standard method of evaporation at atmospheric pressure and a method based on freeze-drying using commercial equipment are compared. The preliminary results of this study obtained with 65Zn sources are presented and a significant improvement of the detection efficiencies to the electron emission for freeze-dried sources is shown. In the course of validation of this method, other radionuclides were studied and, up to now, the results confirm the better crystallization homogeneity achieved for freeze-dried sources.

Half-life determination of 88Y and 89Sr

Half-life measurements have been carried out at LNHB for 88Y using a 4pi gamma-ionisation chamber and for 89Sr using a proportional counter. The determined half-life values and associated standard uncertainties are 106.63 +/- 0.05 d for 88Y and 50.65 +/- 0.05 d for 89Sr, being consistent with relevant values reported in literature. Based on the present results and relevant literature values revised recommended half-life values and associated standard uncertainties are proposed, viz. 106.626 +/- 0.021 d for 88Y and 50.57 +/- 0.03 d for 89Sr.

High-energy resolution X-ray, gamma and electron spectroscopy with cryogenic detectors

Cryogenic detectors offer remarkably better energy resolutions than those achievable with conventional semiconductor or scintillation detectors. With the additional asset of a detection efficiency close to unity for low-energy X-ray photons and electrons, these detectors have the potential to perform X-ray, gamma and electron spectroscopy of a hitherto unknown quality, in particular at low energies. Two types of cryogenic detectors are described and the results of prototype detectors are presented.

The role of cocaine in fatal crashes: first results of the Québec drug study

As part of a major undertaking to establish the contribution of drugs in road crashes in Quebec, the present study focuses on the role of cocaine. Coroner, forensic laboratory and police accident records from April 1999 to December 2000 were matched for 265 fatally injured drivers of passenger vehicles. Cocaine was found in 7.9% of urine samples and 6.0% of blood samples. In order to set up a control group, two roadside surveys were conducted in August 1999 and 2000. The survey sample was distributed proportionately to the number of fatal accidents per time of day and day of the week. During both daytime and nighttime, a total of 11,952 drivers participated in the two surveys among which 11,574 provided a breath sample (96.8%), 8,177 a saliva sample (68.4%) and 5,931 a urine sample (49.6%). Cocaine was detected in 1.1% of urine samples and 1.0% of saliva samples of the driving population. In both fatally injured drivers and driving population, cocaine was found mostly (> 90%) in four main types of combination: cocaine alone, cocaine + cannabis, cocaine + alcohol, cocaine + cannabis + alcohol. The data collected allowed two different analyses: a case-control (urine/urine) and a responsibility analysis (case-case approach) that compares cocaine cases to drug-free cases. Despite some data limitations, all analyses for the four main types of combination clearly suggest that cocaine use plays a role in fatal crashes.

A new set of electronic modules (NIM standard) for a coincidence system using the pulse mixing method

The three electronic modules presented here, connected to two MTR2 modules of extended dead-time discriminators, allow setting-up a complete coincidence system according to the principle of the pulse-mixing method. Results produced by such a system including these modules were compared with those of an older system working in a completely different mode (IMPECC).