PubMed · 16538960
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C A Wolski. 2006. Accommodating largess.. https://pubmed.ncbi.nlm.nih.gov/16538960/
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PURPOSE: To investigate the attenuation of a carbon-fiber tabletop and a combiboard, alongside with the depth-dose profile in a solid-water phantom. MATERIAL AND METHODS: Depth-dose measurements were performed with a Roos chamber for 6- and 10-MV beams for a typical field size (15 cm x 15 cm, SSD [source-surface distance] 100 cm). A rigid-stem ionization chamber was used to measure transmission factors. RESULTS: Transmission factors varied between 93.6% and 97.3% for the 6-MV beam, and 95.1% and 97.7% for the 10-MV photon beam. The lowest transmission factors were observed for the oblique gantry angle of 150 degrees with the table-combiboard combination. The surface dose normalized to a depth of 5 cm increased from 59.4% (without table, 0 degrees gantry), to 108.6% (tabletop present, 180 degrees gantry), and further to 120% (table-combiboard combination) for 6-MV photon beam. For 10 MV, the increase was from 39.6% (without table), to 88.9% (with table), and to 105.6% (table-combiboard combination). For the 150 degrees angle (tablecombiboard combination), the dose increased from 59.4% to 120% (6 MV) and from 39% to 108.1% (10 MV). CONCLUSION: Transmission factors for tabletops and accessories directly interfering with the treatment beam should be measured and implemented into the treatment-planning process. The increased surface dose to the skin should be considered.
OBJECTIVES: We aimed to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharing families to further understand the risks and benefits as well as the effects of infant age and room temperature on bed-sharing behaviors. METHODS: Forty infants who regularly bed shared with > or = 1 parent > or = 5 hours per night were recruited. Overnight video of the family and physiological monitoring of the infant was conducted in infants' homes. Infant sleep position, potential for exposure to expired air, head covering and uncovering, breastfeeding, movements, family sleep arrangements, responses to the infant, and interactions were logged. RESULTS: All infants slept with their mother. Fathers were included in 18 studies and siblings in 4. Infants usually slept beside the mother, separated from the father/siblings (if present), facing the mother, with head at mothers' breast level, touching, or with mother cradling. Median overnight breastfeeding duration was 40.5 minutes. Mothers commonly faced their infant, but infants were rarely in a position that potentially exposed them to maternal expired air. Fathers were seldom in contact with the infant during sleep. Of the 102 head-covering episodes observed in 22 infants, 80% were because of changes in adult sleep position. Sixty-eight percent of head uncovering was facilitated by the mother; half of these events were prompted by the infant. A 1 degree C increase in room temperature decreased infant head covering by 0.2 hours. CONCLUSIONS: The mother-infant relationship is of prime importance during bed sharing, whether the father is present or not. The focus around breastfeeding often dictates the sleep position of the infant and mother, though room temperature may also influence this. In colder rooms infants tend to spend more time with their face covered by bedding. Frequent maternal interactions rely on the ability of the mother to arouse with little stimulation. Mothers, perhaps impaired by alcohol, smoking, or overtiredness, may not be able to respond appropriately.
BACKGROUND: Immobility is associated with complications involving many body systems. OBJECTIVE: To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. METHODS: Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. RESULTS: A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. CONCLUSIONS: Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.