Checking monitor unit calculations using coordinate transformations to calculate off-axis distances in the collimator frame of reference

An important part of treatment-planning QA is to check Monitor Units (MUs) calculated by treatment-planning programs. This is generally straightforward, unless the central axis is blocked. One way to check MUs in this case is to select a reference point in the open portion of the field and use the off-axis distance (OAD), as well as other relevant data, to verify the dose. If wedges are employed in the treatment, the OAD must be specified in the collimator frame-of-reference because one must know where the calculation point is with respect to the wedge to calculate the dose correctly. The purpose of this paper is to describe a method of calculating the OAD in the collimator frame-of-reference using the system of coordinate transformations described by Siddon     

Rate of hepatitis B virus infection in pregnant women determined by a monoclonal hepatitis B surface antigen immunoassay

The rate of HBsAg in 6,976 B-human chorionic gonadotropin (B-hCG)-positive specimens, as determined by the Auszyme Monoclonal assay (Abbott Laboratories, Abbott Park, Ill.), was 0.56% (39 of 6,986 repeatedly reactive [RR] and confirmed-positive specimens). All RR and confirmed specimens were hepatitis B virus positive by at least one additional test, yielding an assay specificity of 99.96%. The findings argue against unique attributes in the pregnant population that might produce inaccurate assay results.     

Autism and the X chromosome: no linkage to microsatellite loci detected using the affected sibling pair method

The etiology of autism spectrum disorders (ASDs) is poorly understood, although it is clear that genetic factors play a major role. ASDs appear to be a heterogeneous group of disorders, making genetic analysis difficult in the absence of etiologically definable subgroups. The excess of males in the affected population has led to suggestions that an X-linked locus could play a role in the causation of autism or a related pervasive developmental disorder. To examine this, we have investigated the genotypes of 31 families with two or more affected boys, at a series of 16 highly polymorphic loci distributed along the X chromosome with an average interlocus distance of 12 cM, in order to identify regions of significantly increased concordance among pairs of affected brothers. No locus tested showed a significant increase in concordance, supporting findings by others that there are no genes of major effect located on the X chromosome that contribute to increased susceptibility to ASD.     

Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families?

BACKGROUND: Limited research has been conducted investigating parent and child behaviour during family interactions in families who have a child with obsessive-compulsive disorder (OCD). While a number of authors in the field of childhood OCD have suggested possible parent and child behaviours that are characteristic of these families, few studies have attempted to explore these in a methodologically sound approach. METHOD: This study compared the observed behaviours of parents and children in families whose children were diagnosed with OCD, to families whose children were diagnosed with other anxiety disorders, externalising disorders and no clinical problems. During family discussions, parent and child behaviours and affect were coded using a Likert-scale system. Family members were rated on behavioural dimensions of control, warmth, doubt, avoidance, confidence, positive problem solving, and rewarding independence. RESULTS: Results indicated that parents and children in the OCD group could be clearly differentiated from families in the other groups based on parent and child behaviour. Mothers and fathers of OCD children were less confident in their child's ability, less rewarding of independence, and less likely to use positive problem solving. Children in the OCD group showed less positive problem solving, less confidence in their ability to solve the problem, and they displayed less warmth during their interactions with their parents. CONCLUSIONS: Parents and children in families where there is a child with OCD behave in a different manner during family interactions to other families. These findings offer interesting and important exploratory information relating to observed parent and child behaviour across different clinical and non-clinical groups. Limitations of this study are addressed and directions for further research are discussed.     

Growing your own CNAs: it's worth the effort

Shortages in healthcare workers are projected to continue for the next few years. This article presents a "how- to" for organizations to attract applicants and develop an in-house training program for Certified Nurse Assistants (CNAs). The process Saint Anthony's Health Center had in executing an in-house certification program and the positive outcome experienced are presented.     

Dealing with colon cancer: one woman's emotional journey

Although death is inevitable, it continues to remain a taboo issue for society. A failure to discuss the unavoidable may represent a safeguard to avoid dealing with mortality and related fears. Many patients who are terminally ill spend their days feeling alone, misunderstood, and afraid. Kubler-Ross attempted to strip death of its negative connotations and to provide a venue for the terminally ill to have a voice. Using information from more than 200 clinical interviews, Kubler-Ross revealed a trend in emotions over time in most, but not all, of her patients, which enabled her to formulate a model of coping with death that included 5 interdependent emotional stages: denial, anger, bargaining, depression, and acceptance. This model has become the most widely accepted and popularized model on death and dying, often cited as the Five Stages of Grief." However, given the lack of research concerning Kubler-Ross's model, completing work in this area seems warranted. The purpose of this case study was to examine one individual's emotional journey after being diagnosed with terminal colon cancer. More specifically, the goals were twofold: (1) to provide the participant with a voice and to allow her story to be told by examining the major external events (ie,surgery, chemotherapy) occurring since the diagnosis that affected her emotional and physical well-being and (2) to determine whether the participant's emotional journey paralleled Kubler-Ross's model, to what extent, and whether new emotions or stages occurred. The participant, a 50-year-old female, was diagnosed with stage 4 Duke Stage D colon cancer. Qualitative information was collected in face-to-face interviews, newspaper articles about the participant, and e-mail correspondence (as form letters to a group of friends and supporters) and subsequently analyzed for trends. The overall results revealed clear existence of the 5 stages of grief as outlined in the Kubler-Ross model. Analyses also revealed that the stages often overlapped or occurred simultaneously. Additionally, the participant regressed to earlier stages when subjected to negative external factors. Four other highly salient emotions were also prevalent throughout the participant's experience with colon cancer, namely joy, fear, hope, and numbness. The findings from this case study help to validate Kubler-Ross's stages. Further, the importance of the voice of the participant cannot be overemphasized. This case study clearly depicts the unique thoughts and emotions during one woman's struggle with colon cancer, sentiments that are often overlooked in quantitative analysis.     

Nursing leadership in Chile: a concept in transition

The purposes of this two-year research study were to uncover Chilean nurses' perspectives of the elements that comprise leadership, and to identify challenges faced by nurse leaders in modern health administration. The research question is, What are the structural components that define and characterize nursing leadership in Chile? Nine nurses from different professional backgrounds volunteered to take part in audiorecorded successive interviews. The research methodology was a kind of grounded theory. Findings suggest that leadership is characterized mainly by exerting a positive influence on others based on good communication, knowledge of management, and a futurist vision of the nursing profession. Crisis and transition in nursing leadership were associated with external and internal forces, such as reforms in healthcare organizations and changes in the nursing conceptual framework.     

Aromatherapy massage: its use in a ward setting

This article describes the properties of essential oils and the use of aromatherapy in a ward setting to treat patients with a variety of conditions. It outlines some of the benefits and risks to patients.