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Incidence involving Dyspepsia within Iran: A planned out Assessment and Meta-analysis.
PURPOSE In a recent article, our group proposed a fast direct aperture optimization (DAO) algorithm for fixed-gantry intensity-modulated radiation therapy (IMRT) called fast inverse direct aperture optimization (FIDAO). When tested on fixed-gantry IMRT plans, we observed up to a 200-fold increase in the optimization speed. Compared to IMRT, rotational volumetric-modulated arc therapy (VMAT) is a much larger optimization problem and has many more delivery constraints. The purpose of this work is to extend and evaluate FIDAO for inverse planning of VMAT plans. METHODS A prototype FIDAO algorithm for VMAT treatment planning was developed in MATLAB using the open-source treatment planning toolkit matRad (v2.2 dev_VMAT build). VMAT treatment plans using one 3600 arc were generated on the AAPM TG-119 phantom, as well as sample clinical liver and prostate cases. The plans were created by first performing fluence map optimization on 28° equispaced beams, followed by aperture sequencing and arc sequencing with a gantry angular sampling rate of 4°. After arc sequencing, a copy of the plan underwent DAO using the prototype FIDAO algorithm, while another copy of the plan underwent DAO using matRad's DAO method, which served as the conventional algorithm. RESULTS Both algorithms achieved similar plan quality, although the FIDAO plans had considerably fewer hot spots in the unspecified normal tissue. The optimization time (number of iterations) for FIDAO and the conventional DAO algorithm, respectively, were 65 s (245) vs 602 s (275) in the TG-119 phantom case; 25 s (85) vs 803 s (159) in the liver case; and 99 s (174) vs 754 s (149) in the prostate case. CONCLUSIONS This study demonstrated promising speed enhancements in using FIDAO for the direct aperture optimization of VMAT plans. © 2020 American Association of Physicists in Medicine.OBJECTIVE Thermal spring waters (TSW) are commonly used as active ingredients in cosmetics. Their biological activities directly depend on the ionic composition of the spring. However, in order to exhibit beneficial properties, the minerals need to reach viable skin layers. The present study addresses the incorporation of marketed TSW in model cosmetic formulations and the impact of the formulation on skin absorption of magnesium and calcium ions that are known to improve skin barrier function. METHODS Marketed TSW was introduced into five formulations. Liposomes were prepared using saturated or unsaturated phospholipids mixed with cholesterol by the thin layer evaporation technique. Emulsions water-in-oil (W/O), oil-in-water (O/W) or double water-in-oil-in-water (W/O/W) were prepared by high shear mixing. Skin absorption of Mg2+ and Ca2+ from those formulations was studied in vitro using static Franz diffusion cells under infinite dose condition and under occlusion of the apparatus. RESULTS Mg2+ and Ca2+ penetrate skin samples from TSW. Encapsulating TSW into double emulsion (TSW/O/W) increased skin absorption of both cations of interest and kept the Ca2+ /Mg2+ ratio equal to that of TSW in each skin layer. The dermal absorption of Mg2+ from the double emulsion departs from both single emulsions. Application of liposome suspension improved the skin absorption of Ca2+ while keeping constant that of Mg2+ , leading to unbalanced Ca2+ /Mg2+ ratio inside skin. CONCLUSION The beneficial effects of TSW are not only due to their action on the skin surface. Their active components, especially Ca2+ and Mg2+ cations reach viable skin layers in a formulation-dependent manner. The distribution of ions inside skin depends on the type of formulation. This article is protected by copyright. All rights reserved.Although studies have shown that mammalian herbivores often limit aboveground carbon storage in savannas, their effects on belowground soil carbon storage remain unclear. Using three sets of long-term, large herbivore exclosures with paired controls, we asked how almost two decades of herbivore removal from a semiarid savanna in Laikipia, Kenya affected aboveground (woody and grass) and belowground soil carbon sequestration, and determined the major source (C3 vs. C4 ) of belowground carbon sequestered in soils with and without herbivores present. Large herbivore exclusion, which included a diverse community of grazers, browsers, and mixed-feeding ungulates, resulted in significant increases in grass cover (~22%), woody basal area (~8 m2 /ha), and woody canopy cover (31%), translating to a ~8.5 t/ha increase in aboveground carbon over two decades. Herbivore exclusion also led to a 54% increase (20.5 t/ha) in total soil carbon to 30-cm depth, with ~71% of this derived from C4 grasses (vs. ~76% with herbivores present) despite substantial increases in woody cover. We attribute this continued high contribution of C4 grasses to soil C sequestration to the reduced offtake of grass biomass with herbivore exclusion together with the facilitative influence of open sparse woody canopies (e.g., Acacia spp.) on grass cover and productivity in this semiarid system. © 2020 by the Ecological Society of America.BACKGROUND AND OBJECTIVES Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. METHODS An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. RESULTS Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P less then .05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. selleck The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). CONCLUSIONS Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. link2 Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.BACKGROUND AND OBJECTIVES Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. link3 METHODS We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs' current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. RESULTS Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. CONCLUSIONS While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.OBJECTIVES Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10-13 years) and examined parent-child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements. METHODS A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month. RESULTS The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution. CONCLUSION Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness. © The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail [email protected] Increased pericardial adipose tissue is associated with higher risk of cardiovascular disease. We aimed to determine if HIV status was independently associated with larger pericardial adipose tissue volume and to explore possible HIV-specific risk factors. METHODS Persons with HIV (PWH) were recruited from the Copenhagen Comorbidity in HIV Infection (COCOMO) Study and matched 11 on age and sex to uninfected controls. Pericardial adipose tissue volume was measured using cardiac CT. RESULTS A total of 587 PWH and 587 controls were included. Median age was 52 years, 88% were male. HIV status was independently associated with 17 mL (95% confidence interval [10, 23]), p less then .001 larger pericardial adipose tissue volume. Larger pericardial adipose tissue volume was associated with low CD4+ nadir and prior use of stavudine, didanosine and indinavir. Among PWH without thymidine analogue or didanosine exposure, time since initiating cART (per 5-year use) was associated with l6 mL [-6, -25] lower pericardial adipose tissue volume, p=.
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