Background Density-based dose point kernel (DPK) scaling accuracy was investigated in various homogeneous tissue media. Methods Using GEometry ANd Tracking 4 Monte Carlo code, DPKs were generated for 5, 8 MeV monoenergetic α particles and 223Ra, 225Ac, and 227Th. Dose was scored in 1 μm thick concentric shells and DPKs were scaled based on the tissue’s mass density and compared with the water DPK. Results Scaled kernels agreed within ±5% except near the Bragg peaks, where they differed up to 25%. Conclusions The authors conclude that kernel scaling based on mass density of the transport medium can be utilized accurately up to 5%, excluding Bragg peak regions.

The aim of this study is to evaluate early and intermediate outcomes and hemodynamics of the latest-generation Trifecta valve implanted using right anterior minithoracotomy.

We performed a single-center, retrospective, observational study including 175 individuals who underwent isolated minimally invasive aortic valve replacement with the latest-generation Trifecta valves through a right anterior minithoracotomy between January 2016 and January 2019. Exclusion criteria for follow-up echocardiographic study included concomitant procedures, conversion to median sternotomy, and nonsurvival during the index admission. Analyses addressed implantation safety, 30-day and intermediate-term survival and hemodynamic performance of the valves.

Overall, patients were followed with duration ranging from 0.5 to 3 years. selleck compound Early (<30 days) mortality occurred in 2 patients (1.1%), and there were 9 (5.1%) late (>30 days) deaths. Early thromboembolic events and postoperative bleeding requiring reoperation occurred atlve can be safely implanted via a minimally invasive approach with excellent early and intermediate outcomes and hemodynamic performance.

Wrestling is a physically demanding sport with an inherently high risk of injury relative to other sports. Injury risk factors may change dramatically for athletes participating in off-season wrestling, given exposure to new opponents, training methods, and wrestling styles compared with in-season months; however, this has never been elucidated in the literature. This study seeks to characterize the injuries sustained while participating in off-season wrestling and compare them to injuries sustained during the in-season months for middle and high school age athletes.

The National Electronic Injury Surveillance System (NEISS) database was queried (2000-2018) to directly compare national estimates and injury characteristics of middle and high school age patients (11-18years of age) presenting to US emergency departments (EDs) with wrestling-associated injuries, stratified by in-season and off-season months.

The average annual number of patients 11 to 18years of age presenting to US EDs with wrestling-assoy more dangerous than in-season wrestling due to changes in wrestling styles or opponent skill levels as the prevalence of specific injury diagnoses between the two seasons is similar.Introduction The burden from infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the European Union/European Economic Area (EU/EEA) has increased in recent years, especially in the higher prevalence southern and eastern countries. Addressing this challenge requires a clear knowledge of the factors driving this epidemiology to inform effective national interventions and campaigns. Methods We identified national quality metrics for antibiotic use and hand hygiene from the 2016/2017 European Centre for Disease Control (ECDC) Point Prevalence study as well as structural, cultural, and governance indicators from other sources. We then utilized general linear modeling to identify parsimonious correlations with national MRSA proportions reported by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results The main process predictor of MRSA prevalence in EU/EEA countries was the use of more than one concurrent antibiotic per patient. The impact of hand hygiene was less clear, possibly because consumption of alcohol hand-rub was suboptimal throughout Europe. Hospital and infection control structural factors did not appear relevant at overall national level. Culture and governance were collectively key predictor groups; uncertainty avoidance, masculinity, and corruption indices strongly correlated with MRSA prevalence. Discussion Our results suggest that the critical antibiotic stewardship factor associated with MRSA in EU/EEA countries is the quality of antibiotic prescribing, especially spectrum of activity, rather than overall consumption levels in hospitals or proportion of patients treated. Above all, MRSA hyperendemicity is correlated with a set of sociocultural behavioral constructs that typically manifest themselves in lack of urgency to address risk and normalization of deviance in relation to noncompliant practices.Background Standardized referral criteria can aid in identifying patients who would benefit from palliative care consultation. Little is known, however, on palliative care team members’ perceptions of these criteria. Objective Describe palliative care programs’ reasons for referral criteria implementation and their perception of the benefits or disadvantages of its use. Design Online survey of National Palliative Care Registry™ participants who use standardized referral criteria. Results Fifty-three programs participated. Late referrals (64.2%) were the most commonly cited reason for referral criteria implementation. The majority (77.4%) felt that referral criteria lead to positive outcomes, including earlier referrals for palliative care-appropriate patients (71.7%). Increases in staff workload and inappropriate referrals were identified as disadvantages of referral criteria use.* Conclusion Palliative care program members identified both benefits and disadvantages of referral criteria use, but felt they had mostly productive results. *Correction added on March 18, 2021 after first online publication of December 18, 2020 In the Results section of the abstract, the third sentence was changed from “Increases in clinical volume and inappropriate referrals were identified as disadvantages of referral criteria use.” to “Increases in staff workload and inappropriate referrals were identified as disadvantages of referral criteria use.”