Using Dashboard Networks to Visualize Multiple Patient Histories: A Design Study on Post-operative Prostate Cancer

In this design study, we present a visualization technique that segments patients' histories instead of treating them as raw event sequences, aggregates the segments using criteria such as the whole history or treatment combinations, and then visualizes the aggregated segments as static dashboards that are arranged in a dashboard network to show longitudinal changes. The static dashboards were developed in nine iterations, to show 15 important attributes from the patients' histories. The final design was evaluated with five non-experts, five visualization experts and four medical experts, who successfully used it to gain an overview of a 2,000 patient dataset, and to make observations about longitudinal changes and differences between two cohorts. The research represents a step-change in the detail of large-scale data that may be successfully visualized using dashboards, and provides guidance about how the approach may be generalized

Hadron cancer therapy complex employing non-scaling FFAG accelerator and fixed field gantry design

Non-scaling FFAG rings for cancer hadron therapy offer reduced physical aperture and large dynamic aperture as compared with scaling FFAGs. The variation of tune with energy implies the crossing of resonances during acceleration. Our design avoids intrinsic resonances, although imperfection resonances must be, and can be, crossed. We consider a system of three non-scaling FFAG rings for cancer therapy with 250 MeV protons and 400 MeV/u carbon ions. Hadrons are accelerated in a common RFQ and linear accelerator, and injected into the FFAG rings at .. .. . H+/C6+ ions are accelerated in the two smaller/larger rings to 31 and 250 MeV/68.8 and 400 MeV/u kinetic energy, respectively. The lattices consist of doublet cells with a straight section for RF cavities. The gantry with triplet cells accepts the whole required momentum range at fixed field. This unique design uses either high temperature super-conductors or super-conducting magnets reducing gantry size and weight. Elements with variable field at beginning and at end set the extracted beam at the correct position for a range of energies

Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low-baseline cognition

Patients with pre-surgery cognitive impairment cannot currently be assessed for cognitive recovery after surgery using the Postoperative Quality of Recovery Scale (PostopQRS),as they would mathematically be scored as recovered. The group nonetheless represent a frail cohort at high risk of recovering poorly. We aimed to validate a novel method to score cognitive recovery in patients with low baseline cognition, using the number of low-score tests rather than their numerical values. Face validity was demonstrated in 86 participants in whom both PostopQRS and an 11-item neuropsychological battery were performed. The PostopQRS agreed with neuropsychological categorization of low versus normal cognition 74% of the time, with all but 5 incorrectly coded participants deviating by only 1 neurocognitive test. Cognitive recovery over time was comparable for groups with differing baseline cognitive function, irrespective of whether PostopQRS or neuropsychological methods were used. Discriminant validation was demonstrated in a post hoc analysis of the Steroids in Cardiac Surgery (SIRS) substudy by allocating groups to normal (n=246) or low baseline cognition (n=231) stratified by cognitive recovery on day 1. Recovery was similar for participants with low and normal baseline cognition. Postoperative length of stay was longer in patients with failed cognitive recovery whether they had normal (10.4±10.0 vs. 8.0±5.9 days, P=0.02) or low baseline cognition (12.0±11.1 vs. 8.2±4.7 days, P<0.01). Overall quality of recovery, as well as cognitive, emotive, and physiological recovery in those who recovered was independent of baseline cognition. The modified scoring method for the PostopQRS cognitive domain therefore demonstrates acceptable face and discriminant validity

Muon Colliders

Muon Colliders have unique technical and physics advantages and disadvantages when compared with both hadron and electron machines. They should thus be regarded as complementary. Parameters are given of 4 TeV and 0.5 TeV high luminosity \mumu colliders, and of a 0.5 TeV lower luminosity demonstration machine. We discuss the various systems in such muon colliders, starting from the proton accelerator needed to generate the muons and proceeding through muon cooling, acceleration and storage in a collider ring. Problems of detector background are also discussed.Comment: 28 pages, with 12 postscript figures. To be published Proceedings of the 9th Advanced ICFA Beam Dynamics Workshop, AIP Pres

Ondansetron does not reduce the shivering threshold in healthy volunteers

Background. Ondansetron, a serotonin-3 receptor antagonist, reduces postoperative shivering. Drugs that reduce shivering usually impair central thermoregulatory control, and may thus be useful for preventing shivering during induction of therapeutic hypothermia. We determined, therefore, whether ondansetron reduces the major autonomic thermoregulatory response thresholds (triggering core temperatures) in humans. Methods. Control (placebo) and ondansetron infusions at the target plasma concentration of 250 ng ml−1 were studied in healthy volunteers on two different days. Each day, skin and core temperatures were increased to provoke sweating; then reduced to elicit peripheral vasoconstriction and shivering. We determined the core-temperature sweating, vasoconstriction and shivering thresholds after compensating for changes in mean-skin temperature. Data were analysed using t-tests and presented as means (sds); P<0.05 was taken as significant. Results. Ondensetron plasma concentrations were 278 (57), 234 (55) and 243 (58) ng ml−1 at the sweating, vasoconstriction and shivering thresholds, respectively; these corresponded to ≈50 mg of ondansetron which is approximately 10 times the dose used for postoperative nausea and vomiting. Ondansetron did not change the sweating (control 37.4 (0.4)°C, ondansetron 37.6 (0.3)°C, P=0.16), vasoconstriction (37.0 (0.5)°C vs 37.1 (0.3)°C; P=0.70), or shivering threshold (36.3 (0.5)°C vs 36.3 (0.6)°C; P=0.76). No sedation was observed on either study day. Conclusions. Ondansetron appears to have little potential for facilitating induction of therapeutic hypothermi

Functionalised tetrathiafulvalene- (TTF-) macrocycles: recent trends in applied supramolecular chemistry

Tetrathiafulvalene (TTF) has been extensively explored as a π-electron donor in supramolecular systems. Over the last two decades substantial advances have been made in terms of constructing elaborate architectures based on TTF and in exploiting the resulting systems in the context of supramolecular host–guest recognition. The inherent electron-donating character of TTF derivatives has led to their use in the construction of highly efficient optoelectronic materials, optical sensors, and electron-transfer ensembles. TTFs are also promising candidates for the development of the so-called “functional materials” that might see use in a range of modern technological applications. Novel synthetic strategies, coupled with the versatility inherent within the TTF moiety, are now allowing the architecture of TTF-based systems to be tuned precisely and modified for use in specific purposes. In this critical review, we provide a “state-of-the-art” overview of research involving TTF-based macrocyclic systems with a focus on their use in supramolecular host–guest recognition, as components in non-covalent electron transfer systems, and in the construction of “molecular machines”

Temperature monitoring: the consequences and prevention of mild perioperative hypothermia

Homeothermic species require a nearly constant internal body temperature. Significant deviations from “normal” internal temperature cause the metabolic function to deteriorate. Usually, the human thermoregulatory system maintains a core body temperature within 0.2°C of normal, near 37°C. Hypothermia results from exposure to cold, or exposure combined with drugs or illness that decrease thermoregulatory efficacy. Exposure to a cold operating room environment during anaesthesia and surgery commonly combines with anaesthetic-induced inhibition of thermoregulation to produce hypothermia. The prevention and management of temperature-related complications is expedited by an understanding of both normal and druginfluenced thermoregulation.Keywords: mild perioperative hypothermia; consequences; preventio

Using small molecules to facilitate exchange of bicarbonate and chloride anions across liposomal membranes

Bicarbonate is involved in a wide range of biological processes, which include respiration, regulation of intracellular pH and fertilization. In this study we use a combination of NMR spectroscopy and ion-selective electrode techniques to show that the natural product prodigiosin, a tripyrrolic molecule produced by microorganisms such as Streptomyces and Serratia, facilitates chloride/bicarbonate exchange (antiport) across liposomal membranes. Higher concentrations of simple synthetic molecules based on a 4,6-dihydroxyisophthalamide core are also shown to facilitate this antiport process. Although it is well known that proteins regulate Cl-/HCO3- exchange in cells, these results suggest that small molecules may also be able to regulate the concentration of these anions in biological systems