A comprehensive method for calculating total body irradiation

PurposeTo provide means for calculating the dose received by various tissues of the patient, calculate lung shield, and verify received dose using a phantom as a tool for quality assurance for a planned Total Body Irradiation (TBI) procedure in radiotherapy.MethodUsing Microsoft Visual Basic, MATLAB, and Python, a program for Total Body Irradiation Calculation in Radiotherapy (TBICR) is constructed. It uses patient translation and beam zone method for total body irradiation calculations to compute the proper dose received by the patient and determine the lung shield thickness. There are three main user-friendly interfaces in the application. The first one allows the user to upload the TBI topography and estimate the distances needed for TBI calculations. The second one enables the user to count the number of beam zones needed for each point and estimate the effective area (A_eff) for each level. The third interface estimates the velocity required to deliver the relative dose depending on patient separation, Monitor Units (MU), couch speed and travel distance. It allows the user to compute the required lung shield thickness, read any patient's CT DICOM file and acquire dose in any distinct location using machine learning model to predict the dose.ResultsThe TBICR software has been successfully validated by reproducing all of the manual calculations in an exact and timely manner. TBICR generated more accurate results and confirmed the absorbed dose to patient through measurements on Anderson phantom.ConclusionsA computer program for the calculation of total body irradiation (TBI) is described in full. The dose received at each point on the patient, the calculation of lung shield and the determination of the velocity and time required for the couch movement are all made possible using the software. The ease of use, precision, data storage and printing are some important features of the present software.     

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws

BackgroundThe Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status.PurposeTo examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope of practice (SOP) laws for nurse practitioners.MethodsUsing data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, the study used a difference-in-differences design that compared outcome changes between expansion and non-expansion states and evaluated whether these changes differed by state SOP laws.DiscussionFollowing Medicaid expansion, forgoing a needed doctor's visit due to cost declined more in expansion states with full SOP laws than states with reduced SOP laws by 3.0 percentage-points in years 1 to 3 after the expansion (p < .05). Furthermore, completing a routine checkup with a doctor increased more in expansion states with full SOP laws by 3.2 percentage-points in 4 to 6 years (p < .05).ConclusionThe ACA Medicaid expansions were associated with larger gains in certain access measures in states with full SOP laws.     

The effects of hallux valgus and walking speed on dynamic balance in older adults

BackgroundHallux valgus (HV) contributes to deficits in static balance and increased fall risk in older adults. Very limited research has examined dynamic balance deficits in walking in this population. These individuals generally walk slowly, as balance challenge is lesser at slow speeds.Research questionHow does the dynamic balance of older adults with HV differ from healthy controls at controlled slow and fast walking speeds?MethodsNineteen older adults with HV and 13 healthy controls completed 5 continuous walking trials at 1.0 and 1.3 m·s⁻¹ as whole body marker position and ground reaction force data were captured. Dynamic balance was evaluated using whole body center of mass (COM) and center of pressure (COP) inclination angles (IA) and duration of double support.ResultsThere were no differences in measures of dynamic balance between older adults with and without HV at slow and fast speeds. At the faster speed, the peak sagittal plane COM-COP IA increased and the double support duration decreased, while the peak frontal plane COM-COP IA were not affected.SignificanceOlder adults with HV do not exhibit deficits in dynamic balance during continuous walking at comfortable speeds when compared to healthy older adults.     

Adverse childhood experiences,inflammation, and depressive symptoms in later life: a prospective cohort study

BackgroundExposure to adverse childhood experiences (ACEs) has been associated with both inflammation and depression. However, little research has examined the potential mediational role of inflammation in the link between ACEs and depression using longitudinal data. Therefore, we investigated the direct and indirect effects of ACEs on inflammation, depression, and their change trajectories over time.MethodsWe used data from the English Longitudinal Study of Ageing. Four ACE categories were assessed retrospectively at wave 3 (2006–07): abuse (physical or sexual abuse or physical assault), family dysfunction (parent arguments, parent mental illness or substance abuse, or parent separation or divorce), poor parent–child bonding (maternal or paternal), and loss of an attachment figure (separation from mother for >6 months, parent death, foster care or adoption, or institutionalisation). A cumulative ACE score was calculated representing the total number of ACEs experienced by the participants. Concentration of C-reactive protein (CRP), an inflammatory marker, was measured at waves 2 (2004–05), 4 (2008–09), and 6 (2012–13). Depressive symptoms were ascertained using the 8-item Centre for Epidemiological Studies Depression Scale from waves 6 to 8 (2016–17). The longitudinal direct and indirect effects of ACEs were estimated using parallel process latent growth curve modelling. All analyses were adjusted for relevant confounders. Missing data were estimated using multiple imputation.ResultsAmong the study sample (N=4382; mean age 70 years; 56% female), 24% of participants reported one ACE and 13% had two or three ACEs. The percentage of participants with three or more depressive symptoms was 21% at baseline. Greater cumulative exposure to ACEs was associated with increased CRP concentration (β=0·042, p=0·010) and depressive symptoms (β=0·164, p<0·0001) at baseline and predicted a steeper increase in these outcomes throughout the study (β_CRP=0·074, p=0·011; β_Depression=0·338, p<0·0001). However, indirect effects of ACEs on depression mediated by CRP were not observed, with only weak associations between CRP and depressive symptoms (β_iDepression=0·032, p=0·173; β_sDepression=0·067, p=0·240). Sensitivity analyses using only somatic depressive symptoms as the outcome revealed a positive association between CRP and somatic symptoms at baseline (β_iDepression=0·068, p=0·008), although the indirect effects remained non-significant in this model.InterpretationBiological mechanisms other than inflammation might underlie the relationship between ACEs and depression. Psychosocial interventions to reduce the negative effects of ACEs on children's development could help to reduce the risk of depression and of other medical conditions linked to inflammation.FundingEconomic and Social Research Council–Biotechnology and Biological Sciences Research Council Soc-B Centre for Doctoral Training (ES/P000347/1).