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PubMed1991

3-D treatment planning and dose delivery verification integrating a variety of state-of-the-art techniques: a case report.

A patient previously treated with radiation for base-of-tongue cancer presented with recurrent disease seven years later. The spinal cord had received tolerance dose. Using state-of-the-art treatment planning techniques, including beam's-eye-view and volumetrics, dose-volume histograms, split field technique, mixed energies, and beam intensity modulation (with a compensator), we achieved uniform dose coverage of the target in 3-D. This was verified in vivo with thermoluminescence dosimeters positioned in the esophagus by means of a nasogastric tube that ran centrally through the target volume. The various techniques applied will be presented with a discussion of the rationale used in each step of plan optimization and verification.

Image Processing, Computer-Assisted↗
PubMedDate not supplied

Master's degree nursing education: state of the art.

This study examines the state of the art in master's nursing education in the United States in light of projected national trends in the health care delivery system. The specific questions addressed are: What are the general characteristics of master's programs, including admission requirements and prerequisites, program requirements, major and minor areas of clinical concentration, functional role preparation, and career mobility options? What is the curricular organization, particularly with respect to required core courses? Is there a difference between master's programs in schools with a doctoral program in nursing and those with master's programs only? Is there a difference between master's programs with public support and master's programs with private support? Data were collected from 175 accredited master's programs in 1990. Study results and the projected trends derived from Nursing's Agenda for Health Care Reform, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy America: Practitioners for 2005 provide the foundation for recommendations. Recommendations are organized around communication and curricular issues that master's nursing education needs to address as the profession approaches the 21st century.

Curriculum↗
PubMed2004

BioMEMS: state-of-the-art in detection, opportunities and prospects.

In recent years, the biological and biomedical applications of micro- and nanotechnology (commonly referred to as Biomedical or Biological Micro-Electro-Mechanical Systems [BioMEMS]) have become increasingly prevalent and have found widespread use in a wide variety of applications such as diagnostics, therapeutics, and tissue engineering. While research and development activity in this field stays intense, some applications have also been commercialized. This article reviews the recent advances in this very exciting and important field and presents a summary of the state of the art in the area of BioMEMS focusing on diagnostics, sensing, and detection. The areas of therapeutics and hybrid bio/artificial devices will be presented in more detail elsewhere [Biomedical Nanotechnology, Vol. I-IV, Maruo Ferrari (Ed.), Kluwer Academic Publishers, 2004, in press.] and here are discussed briefly in terms of future directions and prospects.

Biomimetics↗
PubMed2006

Science and technology of farm animal cloning: state of the art.

Details of the first mammal born after nuclear transfer cloning were published by Steen Malte Willadsen in 1986. In spite of its enormous scientific significance, this discovery failed to trigger much public concern, possibly because the donor cells were derived from pre-implantation stage embryos. The major breakthrough in terms of public recognition has happened when Ian Wilmut et al. [Wilmut, I., Schnieke, A.E., McWhir, J., Kind, A.J., Campbell, K.H., 1997. Viable offspring derived from fetal és adult mammalian cells. Nature 385, 810-813] described the successful application of almost exactly the same method, but using the nuclei of somatic cells from an adult mammal, to create Dolly the sheep. It has become theoretically possible to produce an unlimited number of genetic replicates from an adult animal or a post-implantation foetus. Since 1997 a number of different species including pigs, goats, horses, cats, etc. have been cloned with the somatic cell nuclear transfer technique. Although the technology still has relatively low success rates and there seems to be substantial problems with the welfare of some of the cloned animals, cloning is used both within basic research and the biomedical sector. The next step seems to be to implement cloning in the agricultural production system and several animals have been developed in this direction. This article reviews the current state of the art of farm animal cloning from a scientific and technological perspective, describes the animal welfare problems and critically assess different applications of farm animal cloning. The scope is confined to animal biotechnologies in which the use of cell nuclear transfer is an essential part and extends to both biomedical and agricultural applications of farm animal cloning. These applications include the production of genetically identical animals for research purposes, and also the creation of genetically modified animals. In the agricultural sector, cloning can be used as a tool within farm animal breeding. We do not intend to give an exhaustive review of the all the literature available; instead we pinpoint issues and events pivotal to the development of current farm animal cloning practices and their possible applications.

Animal Welfare↗
PubMed2006

Art, Chaos, Ethics, and Science (ACES): a doctoring curriculum for emergency medicine.

ACES (Art, Chaos, Ethics, and Science) is a curriculum developed by 2 residents and a faculty mentor at the Denver Health Medical Center Emergency Medicine Residency Program. The goal of the ACES curriculum is 2-fold: (1) to discuss areas of clinical consequence typically outside the scope of the regular academic curriculum, such as ethical dilemmas and the challenges of professionalism; and (2) to encourage reflection on our roles as caregivers on a personal, public health, and political level. Each bimonthly "doctoring roundtable" session focuses on one of these goals, bringing local and national leaders in the field to the forum to enrich discussion. Attending physicians from academic and private settings within the residency, residents at all levels, rotating medical students, and, for the past year, emergency department nurses participate in the meetings. Thus far, regular voluntary participation has been the only measure of the ongoing program's success. In this descriptive article, we discuss the aim of the program, the curriculum, and how the ACES program enriches the residency's educational goals. Recent accreditation requirements for residency training programs mandate educational experiences that allow residents to demonstrate competency in professionalism and ethical principles. The ACES curriculum developed a unique niche in our residency, creating an open forum for passionate discussion of challenging clinical encounters, unpressured reflection on ethics and decisionmaking, and constructive personal and professional development.

Colorado↗
PubMed2004

Mastering the art of cemented femoral stem fixation.

Cemented femoral stem fixation is reproducible and provides excellent early recovery of hip function in patients 60 to 80 years old. The durability of fixation has been evaluated up to 20 years with 90% survivorship. Achieving a uniform cement mantle and minimizing polyethylene wear has been shown to reduce the incidence of fixation failure. This article describes the senior author's (C.S.R.) technique for cemented total hip arthroplasty with particular emphasis on the art of cemented femoral stem fixation and his experience with 3 different cemented stem designs over 30 years. The results of using this cement technique with a modern stem design with a surface roughness of 30 to 40 microinches have produced a 95% survivorship at 10- to 20-year follow-up in patients 60 to 80 years old.

Aged↗
PubMed2005

State of the art and recent advances in immunoanalytical systems.

This article is an overview the state of the art and the recent developments in immunosensors. Homogeneous immunosensors, heterogeneous immunosensors, integrated immunosensors and biochip format immunosensors are presented, based on optical, electrochemical, magnetic or mechanical detection/transduction systems.

Biosensing Techniques↗
PubMed2005

Characterisation of wax works of art by gas chromatographic procedures.

To identify the various natural and synthetic substances used by sculptors at the end of the 19th century, several contemporary reference samples were investigated by high temperature gas chromatography (HT GC) and HT GC-MS. Using specific chromatographic conditions and minimising sample preparation, we could separate, detect and identify a wide range of biomolecular markers covering a great variety of molecular weights and volatilities, with a minimum amount of sample, in a single run. Beeswax, spermaceti, carnauba, candellila and Japan waxes as well as pine resin derivatives, animal fats, paraffin, ozokerite and stearin, used as additives in wax works of art, were chemically investigated. In the case of low volatile compounds, transbutylation was performed. The structure of long-chain esters of spermaceti was elucidated for the first time by HT GC-MS analysis. Such a method was then carried out on 10 samples collected on a statuette of Junon by Antoine-Louis Barye (Louvre Museum, Paris, France) and on a sculpture by Aimé-Jules Dalou (Musée de la Révolution Française, Vizille, France). The analytical results obtained provide new data on the complex recipes elaborated by sculptors at the end of the 19th century.

Animals↗
PubMed2006

Science and craftsmanship: the art of experiment and instrument making.

In his two-volume monograph Untersuchungen über thierische Elektricität, the Berlin physiologist Emil du Bois-Reymond described the relation between nervous electricity and muscle mechanics by way of a long series of experiments. This work is a key text in the history of the experimental life sciences. But it not only contains new findings about the functioning of muscles and its nerves. Du Bois-Reymond practiced an art of experimentation in which aesthetics of mechanical craftsmanship allied itself with the science of physiology. Experimentation, as du Bois-Reymond understood it, was simultaneously an epistemic and an aesthetic practice. The goal of his science was thus producing both knowledge and aesthetic success.

Berlin↗
PubMed2006

Primary bone osteosarcoma in the pediatric age: state of the art.

The current combination treatment, chemotherapy and surgery, has significantly improved the cure rate and the survival rate of primary bone osteosarcoma. The 5-year survival rate has increased in the last 30 years from 10% to 70%. Even in patients with poor prognosis, such as those with metastases at diagnosis, the 5-year survival rate has reached 20-30% due to chemotherapy and the surgical removal of metastases and primary tumor. However, the most effective drugs are still the same as those employed over the last 20 years as front line neoadjuvant or adjuvant chemotherapy: Doxorubicin, Cisplatin, Methotrexate, Ifosfamide. No standard, second line therapy exists for those who relapse. At relapse, due to the lack of new non-cross-resistant drugs, surgery is still the main option when feasible. Other drugs have been employed in relapsed patients with poor results. This article reviews the state of the art of treatment for bone osteosarcoma in the pediatric age.

Adolescent↗
PubMed2004

'State of the art' of radical hysterectomy; current practice in European oncology centres.

Quality control of medical performance requires adequate 'state-of-the-art' data and this is currently not uniformly defined for radical hysterectomy. We have used data from a randomised multicentre clinical trial examining the clinical significance of surgical drains following radical hysterectomy (European Organisation for Research and Treatment of Cancer (EORTC)-55962). Although the study was not designed to analyse the quality of the surgical procedure per se, surgical data during and after the operation were carefully noted. A total of 234 patients from 12 European institutes were included in the study. We reported on the clinical and surgical characteristics, the radicality of surgery and short- and long-term complications of radical hysterectomy: median duration of surgery: 240 min; median number of nodes removed: 26; lymph node metastases: 22%; post-operative mortality: <1%; urinary tract infection: 42%; deep venous thrombosis: 3%; fistula: 2%. The data from our study provides an honest and realistic picture of the current practice of radical hysterectomy among European oncology centres and may be considered as the 'standard of care' in this part of the world.

Cancer Care Facilities↗
PubMed2006

Bypassing the learning curve in permanent seed implants using state-of-the-art technology.

PURPOSE: The aim of this study was to demonstrate, based on clinical postplan dose distributions, that technology can be used efficiently to eliminate the learning curve associated with permanent seed implant planning and delivery. METHODS AND MATERIALS: Dose distributions evaluated 30 days after the implant of the initial 22 consecutive patients treated with permanent seed implants at two institutions were studied. Institution 1 (I1) consisted of a new team, whereas institution 2 (I2) had performed more than 740 preplanned implantations over a 9-year period before the study. Both teams had adopted similar integrated systems based on three-dimensional (3D) transrectal ultrasonography, intraoperative dosimetry, and an automated seed delivery and needle retraction system (FIRST, Nucletron). Procedure time and dose volume histogram parameters such as D90, V100, V150, V200, and others were collected in the operating room and at 30 days postplan. RESULTS: The average target coverage from the intraoperative plan (V100) was 99.4% for I1 and 99.9% for I2. D90, V150, and V200 were 191.4 Gy (196.3 Gy), 75.3% (73.0%), and 37.5% (34.1%) for I1 (I2) respectively. None of these parameters shows a significant difference between institutions. The postplan D90 was 151.2 Gy for I1 and 167.3 Gy for I2, well above the 140 Gy from the Stock et al. analysis, taking into account differences at planning, results in a p value of 0.0676. The procedure time required on average 174.4 min for I1 and 89 min for I2. The time was found to decrease with the increasing number of patients. CONCLUSION: State-of-the-art technology enables a new brachytherapy team to obtain excellent postplan dose distributions, similar to those achieved by an experienced team with proven long-term clinical results. The cost for bypassing the usual dosimetry learning curve is time, with increasing team experience resulting in shorter treatment times.

Brachytherapy↗
PubMed2005

Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial.

OBJECTIVES: The long-term (five-year) comparative results of treatment of multivessel coronary artery disease with stenting or coronary artery bypass grafting (CABG) is at present unknown. BACKGROUND: The Arterial Revascularization Therapies Study (ARTS) was designed to compare CABG and stenting in patients with multivessel disease. METHODS: A total of 1,205 patients with the potential for equivalent revascularization were randomly assigned to CABG (n = 605) or stent implantation (n = 600). The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events (MACCE) at one year; MACCE at five-year follow-up constituted the final secondary end point. RESULTS: At five years, there were 48 and 46 deaths in the stent and CABG groups, respectively (8.0% vs. 7.6%; p = 0.83; relative risk [RR], 1.05; 95% confidence interval [CI], 0.71 to 1.55). Among 208 diabetic patients, mortality was 13.4% in the stent group and 8.3% in the CABG group (p = 0.27; RR, 1.61; 95% CI, 0.71 to 3.63). Overall freedom from death, stroke, or myocardial infarction was not significantly different between groups (18.2% in the stent group vs. 14.9% in the surgical group; p = 0.14; RR, 1.22; 95% CI, 0.95 to 1.58). The incidence of repeat revascularization was significantly higher in the stent group (30.3%) than in the CABG group (8.8%; p < 0.001; RR, 3.46; 95% CI, 2.61 to 4.60). The composite event-free survival rate was 58.3% in the stent group and 78.2% in the CABG group (p < 0.0001; RR, 1.91; 95% CI, 1.60 to 2.28). CONCLUSIONS: At five years there was no difference in mortality between stenting and surgery for multivessel disease. Furthermore, the incidence of stroke or myocardial infarction was not significantly different between the two groups. However, overall MACCE was higher in the stent group, driven by the increased need for repeat revascularization.

Coronary Artery Bypass↗
PubMed2005

Microencapsulation by solvent extraction/evaporation: reviewing the state of the art of microsphere preparation process technology.

The therapeutic benefit of microencapsulated drugs and vaccines brought forth the need to prepare such particles in larger quantities and in sufficient quality suitable for clinical trials and commercialisation. Very commonly, microencapsulation processes are based on the principle of so-called "solvent extraction/evaporation". While initial lab-scale experiments are frequently performed in simple beaker/stirrer setups, clinical trials and market introduction require more sophisticated technologies, allowing for economic, robust, well-controllable and aseptic production of microspheres. To this aim, various technologies have been examined for microsphere preparation, among them are static mixing, extrusion through needles, membranes and microfabricated microchannel devices, dripping using electrostatic forces and ultrasonic jet excitation. This article reviews the current state of the art in solvent extraction/evaporation-based microencapsulation technologies. Its focus is on process-related aspects, as described in the scientific and patent literature. Our findings will be outlined according to the four major substeps of microsphere preparation by solvent extraction/evaporation, namely, (i) incorporation of the bioactive compound, (ii) formation of the microdroplets, (iii) solvent removal and (iv) harvesting and drying the particles. Both, well-established and more advanced technologies will be reviewed.

Chemistry, Pharmaceutical↗
PubMed2006

Assessment of state-of-the-art models for predicting the remobilisation of radionuclides following the flooding of heavily contaminated areas: the case of Pripyat River floodplain.

The performances of models are assessed to predict the wash-off of radionuclides from contaminated flooded areas. This process should be accounted for in the proper management of the aftermath of a nuclear accident. The contamination of the Pripyat River water following the inundation of a floodplain heavily contaminated by (90)Sr and (137)Cs of Chernobyl origin is used as the basis for modelling. The available experimental evidence demonstrated that remobilisation of radiostrontium is an important process implying a significant secondary radioactive load of water flowing over the contaminated floodplain. On the contrary, there is no empirical evidence of a similar behaviour for radiocaesium. In general, state-of-the-art models properly predicted the remobilisation of strontium, whereas they significantly overestimated radiocaesium concentrations in water. The necessary model improvements for a more accurate prediction of radiocaesium contamination levels include a reassessment of the values of the model parameters controlling the remobilisation process.

Cesium Radioisotopes↗
PubMed2005

Lipodystrophy and serum lipid abnormalities in HIV-positive sub-Saharan population on ART.

To evaluate whether racial factors may be involved in the development of ART-induced lipodystrophy and/or lipid serum abnormalities, we carried-out a case-control study on all 23 consecutive anti-HIV-positive sub-Saharan black African patients observed from September 20fc01 to December 2001 ('Cases') and 23 Caucasian 'Controls' pair-matched for sex, age (+/-5 years), number of CD4 cells (+/-100 cells), clinical stage of HIV infection, overall duration (+/-3 months) of anti-retroviral treatment and type and duration (+/-3 months) of the last anti-retroviral regimen. The cases, as compared with the controls, less frequently showed lipodystrophy (4.4 vs. 65.2%, P<0.001) and hypertriglyceridemia (8.8 vs. 56.5%, P<0.005), whereas the prevalence of subjects with hypercholesterolemia was similar in the two groups (30 and 39.1%, respectively). Overall, the prevalence of patients lacking both lipodystrophy and serum lipid abnormalities was markedly higher for the cases than for the controls (69.5 vs. 13%, P<0.001). This study seems to indicate that anti-retroviral-induced lipodystrophy and hypertriglyceridemia may be associated to some racial factor.

Adult↗
PubMed2005

A novel method of cocaine delivery to fruit flies using a graphic arts airbrush.

The fruit fly Drosophila melanogaster is a model system for studying pathways regulating responses to cocaine. We describe a new method for delivering cocaine to Drosophila. Freebase cocaine dissolved in ethanol is sprayed onto cold-anaesthetized flies using a graphic arts airbrush modified to reproducibly control the drug dosage. Cocaine dose response curves were generated to characterize the behavioral responses of flies using the airbrush method or the established cocaine smoke method of drug delivery. The stereotypic responses observed with the airbrush showed a dose-dependent increase and were qualitatively similar to those elicited by cocaine smoke. The variation in behaviors of flies dosed with the airbrush was smaller than that of the smoke-dosed flies, indicating that the airbrush method gives better reproducibility. Since flies are exposed to alcohol as well as cocaine in the airbrush behavioral paradigm, it was important to control for possible effects of ethanol. Control experiments indicated that none of the stereotypies elicited with cocaine were caused by vehicle alone and very little ethanol remains in the flies following this protocol. The utility of the airbrush method was demonstrated by its use in a pilot genetic screen that identified a cocaine resistant mutant.

Animals↗
PubMed2005

Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery.

PURPOSE: We describe state-of-the-art software and hardware requirements for the manufacture of high quality medical models manufactured using medical rapid prototyping. The limitations of medical models, the source of artefacts, and their physical appearance are illustrated along with remedies for their removal. MATERIALS AND METHODS: Medical models were built using predominantly stereolithography and fused deposition modeling at both institutions over a period of 6 years. A combined total of 350 models have been produced for a range of maxillofacial, neurosurgical, and orthopedic applications. Stereolithography, fused deposition modeling, computerized numerical milling, and other technologies are described along with computer software requirements. RESULTS: A range of unwanted artefacts that create distortions on medical models have been identified. These include data import, computed tomography gantry distortion, metal, motion, surface roughness due to support structure removal or surface modeling, and image data thresholding. The source of the artefact has been related to the patient, imaging modality performance, or the modeling technology. Discussion as to the significance of the artefacts on clinical use is provided. CONCLUSIONS: It is recommended that models of human anatomy generated by medical rapid prototyping are subject to rigorous quality assurance at all stages of the manufacturing process. Clinicians should be aware of potential areas for inaccuracies within models and review the source images in cases where model integrity is in doubt.

Artifacts↗