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Anxious Care: Radioactive Uncertainty and the Politics of Life in Post-Nuclear Japan
No full textSince the 2011 meltdown, the health of “Fukushima children” has become a problem for parents, politics, and future imaginaries in post-nuclear Japan. What are the ethical and political implications of making life around a child imperiled by radiation when (re)productivity of life must be remade in a compromised environment? This dissertation investigates (re)production of life in the wake of the Fukushima Daiichi nuclear disaster in Japan by studying the strivings of families who seek to raise healthy children amidst radiation as a condition of living: what I call “anxious care.” By foregrounding the family as a site for environmental struggles in an emerging politics of life, I examine the work of making children live against and within radiation, looking to consider the radical implications of caring for children in radioactive uncertainty. In particular, this project focuses on inner cities of Fukushima Prefecture that have been on the frontline of radiation debates for having been exposed to disaster-induced radiation while not designated for evacuation. Shifting focus to the edges of delimited disaster zones, I examine the multifaceted aftermath of the nuclear disaster, ranging from differentially altered forms of life conditioned by radioactive uncertainty, the unequal distribution of radiation risk through public/private organizations such as the family form, and the everyday impact of post-Fukushima radiation. Theorizing the stakes of living with nuclear risk as situated political ecologies which generates tensions and possibilities for new forms of life, this dissertation argues that notions of life are undergoing a moment of reconfiguration in post-nuclear Japan by both real-life families and the family form. In doing so, it contributes to critiquing and broadening the anthropological horizons of life amid environmental uncertainty in and beyond Japan.</p
Body Mass and Tail Girth Predict Hibernation Expression in Captive Dwarf Lemurs.
No full textAbstractHibernation, a metabolic strategy, allows individuals to reduce energetic demands in times of energetic deficits. Hibernation is pervasive in nature, occurring in all major mammalian lineages and geographical regions; however, its expression is variable across species, populations, and individuals, suggesting that trade-offs are at play. Whereas hibernation reduces energy expenditure, energetically expensive arousals may impose physiological burdens. The torpor optimization hypothesis posits that hibernation should be expressed according to energy availability. The greater the energy surplus, the lower the hibernation output. The thrifty female hypothesis, a variation of the torpor optimization hypothesis, states that females should conserve more energy because of their more substantial reproductive costs. Contrarily, if hibernation's benefits offset its costs, hibernation may be maximized rather than optimized (e.g., hibernators with greater fat reserves could afford to hibernate longer). We assessed torpor expression in captive dwarf lemurs, primates that are obligate, seasonal, and tropical hibernators. Across 4.5 mo in winter, we subjected eight individuals at the Duke Lemur Center to conditions conducive to hibernation, recorded estimates of skin temperature hourly (a proxy for torpor), and determined body mass and tail fat reserves bimonthly. Across and between consecutive weigh-ins, heavier dwarf lemurs spent less time in torpor and lost more body mass. At equivalent body mass, females spent more time torpid and better conserved energy than did males. Although preliminary, our results support the torpor optimization and thrifty female hypotheses, suggesting that individuals optimize rather than maximize torpor according to body mass. These patterns are consistent with hibernation phenology in Madagascar, where dwarf lemurs hibernate longer in more seasonal habitats
Oropharyngeal Dysphagia in Infants and Children with Infantile Pompe Disease.
No full textPompe disease is a rare genetic progressive neuromuscular disorder. The most severe form, infantile Pompe disease, has historically resulted in early mortality, most commonly due to cardiorespiratory failure. Treatment with enzyme replacement therapy (ERT) using alglucosidase alfa (Myozyme((R))) has extended the lifespan of individuals with this disease. With the introduction of ERT and the resultant improved survival, dysphagia is being encountered clinically with increasing regularity though systematic data remain unavailable. We retrospectively studied the oropharyngeal swallowing of 13 infants and children with Pompe disease using videofluoroscopy before initiation of ERT, allowing for baseline swallow function to be established in an untreated cohort. Dysphagia was present in all 13 subjects, even in a participant only 15 days old. Oral stage signs were present in 77%, most frequently a weak suck in 69%. Pharyngeal stage signs were present in 100%, including a pharyngeal swallow delay in 92% and pharyngeal residue in 77%. Airway invasion was present in 76.9% of subjects, including penetration in five (38.46%) and silent aspiration in an additional five (38.46%). No relationship in the relative involvement of swallowing, gross motor function, and cardiac disease appeared to be present
Situation awareness and interruption handling during medication administration
No full textMedication administration error remains a leading cause of preventable death. A gap exists in understanding attentional dynamics, such as nurse situation awareness (SA) while managing interruptions during medication administration. The aim was to describe SA during medication administration and interruption handling strategies. A cross-sectional, descriptive design was used. Cognitive task analysis (CTA) methods informed analysis of 230 interruptions. Themes were analyzed by SA level. The nature of the stimuli noticed emerged as a Level 1 theme, in contrast to themes of uncertainty, relevance, and expectations (Level 2 themes). Projected or anticipated interventions (Level 3 themes) reflected workload balance between team and patient foregrounds. The prevalence of cognitive time-sharing during the medication administration process was remarkable. Findings substantiated the importance of the concept of SA within nursing as well as the contribution of CTA in understanding the cognitive work of nursing during medication administration
NP and PA transition to practice: A scoping review of fellowships and onboarding programs.
No full textObjectivesNewly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs.MethodsUsing the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles.ResultsThe pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers.ConclusionsA gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas
Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade.
No full textObjectiveRecombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to increase fusion rates; however, cost, limited FDA approval, and possible complications impact its use. Decisions regarding rhBMP-2 use and changes over time have not been well defined. In this study, the authors aimed to assess changes in rhBMP-2 use for adult spinal deformity (ASD) surgery over the past decade.MethodsA retrospective review of the International Spine Study Group prospective multicenter database was performed to identify ASD patients treated surgically from 2008 to 2018. For assessment of rhBMP-2 use over time, 3 periods were created: 2008-2011, 2012-2015, and 2016-2018.ResultsOf the patients identified, 1180 met inclusion criteria, with a mean age 60 years and 30% of patients requiring revision surgery; rhBMP-2 was used in 73.9% of patients overall. The mean rhBMP-2 dose per patient was 23.6 mg. Patients receiving rhBMP-2 were older (61 vs 58 years, p 0; 68% vs 62%, p = 0.026), a greater deformity correction (change in pelvic incidence minus lumbar lordosis 15° vs 12°, p = 0.01), and more levels fused (8.9 vs 7.9, p = 0.003). Over the 3 time periods, the overall rate of rhBMP-2 use increased and then stabilized (62.5% vs 79% vs 77%). Stratified analysis showed that after an overall increase in rhBMP-2 use, only patients who were younger than 50 years, those who were smokers, those who received a three-column osteotomy (3CO), and patients who underwent revision sustained an increased rate of rhBMP-2 use between the later two periods. No similar increases were noted for older patients, nonsmokers, primary surgery patients, and patients without a 3CO. The total rhBMP-2 dose decreased over time (26.6 mg vs 24.8 mg vs 20.7 mg, p ConclusionsThe authors found that rhBMP-2 was used in the majority of ASD patients and was more commonly used in those with greater deformity correction. Additionally, over the last 10 years, rhBMP-2 was increasingly used for ASD patients, but the dose has decreased
US Patent 8481771 - Biodiesel Process
No full textProcesses for producing biodiesel compositions are disclosed. FFAs present in the triglycerides can be removed by reaction with isobutylene, or by Kolbe electrolysis. The Kolbe electrolysis can be performed on the starting material, or on the crude glycerol. The triglycerides are transesterified to form alkyl esters of the fatty acids and glycerol. The transesterification reaction can be catalyzed by an alkoxide, rather than a hydroxide, to help keep the glycerol by-product dry. The alkoxide salt can be neutralized by reaction with a dry acid, such as gaseous hydrogen chloride or sulfuric acid, and the resulting alcohol removed by distillation, and at least a portion of the neutralized salt can be removed by filtration or decantation. The process can provide improved biodiesel yields, and glycerol pure enough for use directly in glycerol ether manufacture
Image-based longitudinal assessment of external beam radiation therapy for gynecological malignancies
No full textThis thesis consists of two studies. Study 1 is an assessment of dose-volume metrics of an 18F-FDG PET adaptive radiation therapy for vulvar and cervical cancer patients.Study 2 is an evaluation of cumulative dose distributions from external beam radiation therapy using CT-to-CBCT deformable image registration (DIR) for cervical cancer patients.Study 1: Assessment of dose-volume metrics of an 18F-FDG PET adaptive radiation therapy for vulvar and cervical cancer patientsPurpose: Adaptive radiation therapy (ART) enables treatment to be modified with the goal of improving the dose distribution to the patient due to changes in anatomy. Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) is used for staging, treatment planning, and assessing treatment response, but can also be used to adapt treatment. In an adaptive PET/CT study, an additional PET/CT scan is acquired for planning purposes after a certain prescribed dose has been delivered. The intratreatment PET/CT is used to re-contour the volumes and create a new treatment plan that is used to deliver the remaining dose for the treatment. The goal of adaptive radiation therapy (ART) is to reduce the dose to normal tissues while maintaining the prescribed dose to the adapted PTV.
Materials and Methods: In this IRB-approved protocol, patients with vulvar and cervical cancer received a planning PET/CT and an intratreatment PET/CT. Radiation therapy consisted of either intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) with 1.8 Gy once daily to a total of 45 to 50.4 Gy and simultaneous integrated boosts (SIB) to involved pelvic or para-aortic (PA) lymph nodes. The primary tumor was treated to 64.4 to 66.4 Gy with sequential boosts for the vulvar cancer patients. Cervical cancer patients were boosted with brachytherapy. SIB dose ranged from a total of 64.4 Gy to 66.4 Gy in 25 fractions determined by the treating physician and organs-at risk (OAR) tolerance. An intratreatment PET/CT was obtained at 12-20 fractions when the delivered dose was between 30 to 36 Gy. All patients were re-planned with revised OAR, gross tumor volume (GTV) and planning target volume (PTV) contours. The same dose goals remained on the adapted plan. Dosimetric metrics for OARs were compared using the Wilcoxon signed rank test. The criteria for determining statistical significance was established as a p-value less than 0.05.
Results: In the vulvar analysis, out of 20 eligible patients, ART resulted in significant reductions in OAR doses. For bladder, max dose (Dmax) median reduction (MR) was 1.1 Gy ((IQR 0.48 – 2.3 Gy), p < 0.001) and for D2cc MR was 1.5 Gy ((IQR 0.51 – 2.1 Gy), p < 0.001). For bowel, Dmax MR was 1.0 Gy ((IQR 0.11 – 2.9 Gy), p < 0.001), for D2cc MR was 0.39 Gy ((IQR 0.023 – 1.7 Gy), p < 0.001), and for D15cc MR was 0.19 Gy ((IQR 0.026 – 0.47 Gy), p = 0.002)). For rectum, mean dose (Dmean) MR was 0.66 Gy ((IQR 0.17 – 1.7 Gy) p = 0.006) and for D2cc MR was 0.46 Gy ((IQR 0.17 – 0.80 Gy), p = 0.006). Thirty-seven cervical patients were analyzed. ART resulted in significant reductions in OAR doses. For bladder, max dose (Dmax) median reduction (MR) was 0.89 Gy ((IQR 0.23 – 2.14 Gy), p = 0.001) and for D2cc MR was 0.38 Gy ((IQR 0.12 – 1.36 Gy), p<0.0001). For bowel, Dmax MR was 3.27 Gy ((IQR 0.50 – 5.41 Gy), p < 0.0001). For D2cc MR was 2.09 Gy ((IQR 0.30 – 4.97 Gy), p < 0.0001), and for D15cc MR was 0.57 Gy (IQR 0.22 – 2.07 Gy)). For rectum, Dmean MR was 0.13 Gy ((IQR 0.09 – 0.24 Gy) p = 0.0025), and for D2cc MR was 0.44 Gy ((IQR 0.14 – 1.02 Gy), p < 0.0001).
Conclusions: Based on the analysis and response to ART of 20 eligible patients with vulvar cancer and 37 eligible patients with cervical cancer, it can be concluded that ART resulted in a significant reduction in OAR doses, including bladder, bowel, and rectum. Overall, these findings suggest that ART can effectively reduce the radiation dose to OARs and improve treatment outcomes for patients with gynecological cancers. Study 2: Evaluation of cumulative dose distributions from external beam radiation therapy using CT-to-CBCT deformable image registration (DIR) for cervical cancer patients
Purpose: Organ motion during radiation therapy in the pelvic region can potentially lead to uncertainties with the dose delivered to critical organs during fractionated treatment. The purpose of this study is to investigate, by means of using deformable image registration (DIR) and dose summation techniques, the differences between the planning dose and the delivered dose as calculated from the longitudinal cone-beam CT (CBCT) images for cervical cancer patients.
Materials and Methods: Cervical cancer patients treated with external beam radiation therapy (EBRT) received a planning CT (pCT) and five CBCTs, once every five fractions of treatment. The “Merged CBCT” feature in MIM Maestro (MIM Software, Cleveland, OH) was performed between the pCT and each CBCT to generate an extended field-of-view (FOV) CBCT (mCBCT). A free-form multi-modality DIR was then performed between the pCT and the mCBCT to deform the pCT structures onto the mCBCT. DIR-generated bladder and rectum contours were further adjusted by a physician, and Dice Similarity Coefficients (DSC) were calculated between the two. After deformation, the investigated doses on the mCBCT were: 1) recalculated in Eclipse TPS (Varian Medical Systems, Palo Alto, CA) using original plan parameters (ecD), and 2) deformed from planning dose (pD) using the deformation matrix (mdD). Dose summation was performed to the first week’s mCBCT. Bladder D2cc, Dmax, Dmean, V45, and D50, rectum D2cc, Dmax, Dmean, and D50, and PTV45 D90 and D98 were compared between the three calculated doses. Dose distributions were compared in terms of dose volume histograms (DVHs) and gamma analysis. The Wilcoxon signed rank test was used to compare dosimetric metrics with statistical significance defined at p < 0.05.
Results: For the ten patients analyzed, the average DSC were 0.72 ± 0.15 for bladder and 0.80 ± 0.11 for rectum. For most cases, only the superior and inferior slices were edited by physician. Regardless of the method of dose calculation (ecD or mdD), D2cc (bladder and rectum), and D90 and D98 (PTV45) were within 5% of pD for at least 9 out of 10 patients. For one patient each for bladder, rectum, and PTV45, the agreement was worse than 5%, with the largest difference of 15.3% for bladder D2cc in a patient with large bladder filling differences. For the Eclipse calculated dose on the merged CBCT (ecD) and t;he MIM deformed dose on merged CBCT (mdD), the bladder Dmax was within 5% for 8 out of 10 patients, and rectum Dmax was within 5% for 7 out of 10 patients. All 10 patients for ecD and mdD were >5% for bladder V45 due to the large variations in bladder volume throughout treatment. Statistically significant differences for bladder D2cc between the ecD and the mdD (p = 0.047). For bladder D50, significant differences between pD and ecD (p = 0.009) and ecD and mdD (p = 0.005). Statistically significant differences for rectum D2cc between the pD and ecD (p = 0.028) as well as ecD and mdD (p = 0.005). Statistically significant differences for D98 between the pD and ecD (p = 0.028) and pD and mdD (p = 0.007). The gamma analysis between the ecD and pD matched 90% of the voxels for 3 out of 10 patients and between the mdD and pD for 1 out of 10 patients.
Conclusions: In this study, we evaluated cumulative doses based on weekly CBCTs using a commercially-available DIR software. Using DIR and the new Merged CBCT feature, we determined that reporting the initial planning dose would not introduce a more than 5% difference in 90% of cases studied. Our results indicate that the mdD produces similar dose values as the ecD for the OARs and PTV. The proposed workflow should be used on a case-by-case basis when the weekly CBCT shows marked difference in organs-at-risk from the planning CT.
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Improving Veteran Access to Integrated Management of Back Pain (AIM-Back): Protocol for an Embedded Pragmatic Cluster-Randomized Trial.
No full textBackgroundCoordinated efforts between the National Institutes of Health, the Department of Defense, and the Department of Veterans Affairs have built the capacity for large-scale clinical research investigating the effectiveness of nonpharmacologic pain treatments. This is an encouraging development; however, what constitutes best practice for nonpharmacologic management of low back pain (LBP) is largely unknown.DesignThe Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) trial is an embedded pragmatic cluster-randomized trial that will examine the effectiveness of two different care pathways for LBP. Sixteen primary care clinics will be randomized 1:1 to receive training in delivery of 1) an integrated sequenced-care pathway or 2) a coordinated pain navigator pathway. Primary outcomes are pain interference and physical function (Patient-Reported Outcomes Measurement Information System Short Form [PROMIS-SF]) collected in the electronic health record at 3 months (n=1,680). A subset of veteran participants (n=848) have consented to complete additional surveys at baseline and at 3, 6, and 12 months for supplementary pain and other measures.SummaryAIM-Back care pathways will be tested for effectiveness, and treatment heterogeneity will be investigated to identify which veterans may respond best to a given pathway. Health care utilization patterns (including opioid use) will also be compared between care pathways. Therefore, the AIM-Back trial will provide important information that can inform the future delivery of nonpharmacologic treatment of LBP