Performance of the improved larger acceptance spectrometer: VAMOS Rejmund, M.; Lecornu, B.; Navin, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
08/2011, Letnik:
646, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Measurements and ion optic calculations showed that the large momentum acceptance of the VAMOS spectrometer at GANIL could be further increased from
∼
11
%
to
∼
30
%
by suitably enlarging the ...dimensions of the detectors used at the focal plane. Such a new detection system built for the focal plane of VAMOS is described. It consists of larger area detectors (1000
mm×150
mm) namely, a Multi-Wire Parallel Plate Avalanche Counter (MWPPAC), two drift chambers, a segmented ionization chamber and an array of Si detectors. Compared to the earlier existing system (VAMOS), we show that the new system (VAMOS++) has a dispersion-independent momentum acceptance. Additionally, a start detector (MWPPAC) has been introduced near the target to further improve the mass resolution to
∼
1
/
220
. The performance of the VAMOS++ spectrometer is demonstrated using measurements of residues formed in the collisions of
129Xe at 967
MeV on
197Au.
A new segmented silicon-array called MUSETT has been built for the study of heavy elements using the Recoil-Decay-Tagging technique. MUSETT is located at the focal plane of the VAMOS spectrometer at ...GANIL and is used in conjunction with a γ-ray array at the target position. This paper describes the device, which consists of four 10×10cm2 Si detectors and its associated front-end electronics based on highly integrated ASICs electronics. The triggerless readout electronics, the data acquisition and the analysis tools developed for its characterization are presented. This device was commissioned at GANIL with the EXOGAM γ-ray spectrometer using the fusion–evaporation reaction 197Au(22Ne,5n)214Ac. Additionally, the performance of the VAMOS Wien filter used during the in-beam commissioning is also reported.
New gas-filled mode of the large-acceptance spectrometer VAMOS Schmitt, C.; Rejmund, M.; Navin, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
09/2010, Letnik:
621, Številka:
1
Journal Article
Recenzirano
Odprti dostop
A new gas-filled operation mode of the large-acceptance spectrometer VAMOS at GANIL is reported. A beam rejection factor greater than 10
10 is obtained for the
40Ca+
150Sm system at 196
MeV. The ...unprecedented transmission efficiency for the evaporation residues produced in this reaction is estimated to be around 80% for
α
x n channels and above 95% for
x n
y p channels. A detailed study of the performance of the gas-filled VAMOS and future developments are discussed. This new operation mode opens avenues to explore the potential of fusion reactions in various kinematics.
A compact, quasi-
4
π
position sensitive silicon array, TIARA, designed to study direct reactions induced by radioactive beams in inverse kinematics is described here. The Transfer and Inelastic ...All-angle Reaction Array (TIARA) consists of 8 resistive charge division detectors forming an octagonal barrel around the target and a set of double-sided silicon-strip annular detectors positioned at each end of the barrel. The detector was coupled to the
γ
-ray
array EXOGAM and the spectrometer VAMOS at the GANIL Laboratory to demonstrate the potential of such an apparatus with radioactive beams. The
N
(
d
,
p
)
14
N
15
reaction, well known in direct kinematics, has been carried out in inverse kinematics for that purpose. The observation of the
N
15
ground state and excited states at 7.16 and 7.86
MeV is presented here as well as the comparison of the measured proton angular distributions with DWBA calculations. Transferred
l-values are in very good agreement with both theoretical calculations and previous experimental results obtained in direct kinematics.
A compact, quasi-4pi position sensitive silicon array, TIARA, designed to study direct reactions induced by radioactive beams in inverse kinematics is described here. The Transfer and Inelastic ...All-angle Reaction Array (TIARA) consists of 8 resistive charge division detectors forming an octagonal barrel around the target and a set of double-sided silicon-strip annular detectors positioned at each end of the barrel. The detector was coupled to the -ray array EXOGAM and the spectrometer VAMOS at the GANIL Laboratory to demonstrate the potential of such an apparatus with radioactive beams. The 14N(d,p)15N reaction, well known in direct kinematics, has been carried out in inverse kinematics for that purpose. The observation of the 15N ground state and excited states at 7.16 and 7.86 MeV is presented here as well as the comparison of the measured proton angular distributions with DWBA calculations. Transferred l-values are in very good agreement with both theoretical calculations and previous experimental results obtained in direct kinematics.
Osteosarcoma of the Jaws: Factors Influencing Prognosis LeCornu, Megan Granowski, DMD; Chuang, Sung-Kiang, DMD, MD, DMSc; Kaban, Leonard B., DMD, MD ...
Journal of oral and maxillofacial surgery,
09/2011, Letnik:
69, Številka:
9
Journal Article
Recenzirano
Purpose To evaluate patient, tumor, and treatment variables associated with survival in patients with jaw osteosarcoma (JOS) and to compare survival in patients treated before 1991 with those managed ...with more aggressive treatment protocols since 1992. Patients and Methods This is a retrospective cohort study of patients with JOS treated at Massachusetts General Hospital from 1967 through 2007. Patients were divided by treatment date into Group 1, 1967 to 1991 ( n = 30) and Group 2, 1992 to 2009 ( n = 17). Medical records were reviewed to collect the following: demographic, radiographic, tumor-specific, treatment, and survival data. The 2 subgroups were statistically compared. Results There were 47 patients (32 males, 15 females) with a mean age of 30.9 years (range 4 to 74). Mandibular location showed a trend toward improved survival ( P = .06). Average tumor size was 4.38 cm (range 0.5 to 9.0 cm). Larger tumors were associated with decreased overall survival ( P = .016). Higher grade tumors had decreased overall survival ( P = .01). Clear surgical margins were obtained in 67% of patients. Clear surgical margins correlated with improved survival ( P = .002). Maxillary JOS constituted 83% of those with positive margins. Overall, 5-year survival was 68%. Improved 5-year survival was noted in group 2 (77%) compared with group 1 (52%) P = .0073. Patients who developed secondary osteosarcomas (n = 10) had 4.5-fold increased risk of death ( P = .01). Recurrence was associated with 7-fold increased risk of death ( P = .0008). Thirteen patients died of JOS. Conclusions Improved survival was noted in treatment group 2. This group benefited from improved imaging, earlier diagnosis and more aggressive treatment that included improved surgical clearance. A clear survival advantage for neoadjuvant chemotherapy was not demonstrated.
Background: Analyzing MR scans of low-grade glioma, with highly accurate segmentation will have an enormous potential in neurosurgery for diagnosis and therapy planning. Low-grade gliomas are mainly ...distinguished by their infiltrating character and irregular contours, which make the analysis, and therefore the segmentation task, more difficult. Moreover, MRI images show some constraints such as intensity variation and the presence of noise.
Methods: To tackle these issues, a novel segmentation method built from the local properties of image is presented in this paper. Phase-based edge detection is estimated locally by the monogenic signal using quadrature filters. This way of detecting edges is, from a theoretical point of view, intensity invariant and responds well to the MR images. To strengthen the tumor detection process, a region-based term is designated locally in order to achieve a local maximum likelihood segmentation of the region of interest. A Gaussian probability distribution is considered to model local images intensities.
Results: The proposed model is evaluated using a set of real subjects and synthetic images derived from the Brain Tumor Segmentation challenge –BraTS 2015. In addition, the obtained results are compared to the manual segmentation performed by two experts. Quantitative evaluations are performed using the proposed approach with regard to four related existing methods.
Conclusion: The comparison of the proposed method, shows more accurate results than the four existing methods.
•Local phase information is intensity invariant.•Local phase information is integrated instead the gradient of intensity.•Region based term enhanced the proposed segmentation approach.•The obtained results seem promising for both real and BRATS 2015 challenge.
Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in ...BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age.
In a cross-sectional study, we included 353 patients divided into two age-groups (16-46; 47-71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions.
A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030).
We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.
L’ARS Occitanie autorisait par arrêté en 2015, le protocole de coopération entre professionnels de santé intitulé : « Élargissement des missions du diététicien en matière de dénutrition, nutrition ...entérale et parentérale en lieu et place d’un médecin ». L’objectif de ce travail est de présenter l’activité un an après la mise en place de ce protocole au sein de notre établissement.
Une unité transversale de nutrition était créée en 2008. Un formulaire informatisé était développé et mis en œuvre au sein de l’équipe. Il intégrait tous les critères nécessaires à la prise en charge des patients en nutrition clinique en accord avec les recommandations nationales et internationales. En 2015, avec la même équipe, il était décidé de mettre en place le PCMD. Le même formulaire était redéployé en intégrant les nouveaux indicateurs du programme en plus des critères déjà existants. Ces indicateurs étaient implémentés grâce au travail des médecins et diététiciens nutritionnistes, du département d’information médicale, des biostatisticiens, de la cellule qualité et du service des ressources humaines. Les données sont présentées sous formes quantitatives.
Entre le 01/01/2018 et le 31/12/2018, 1382 patients étaient inclus dans le programme sur 1385 patients éligibles et informés. Le taux d’adhésion au protocole était de 99.78 %. Un total de 172 patients inclus dans le protocole bénéficiaient d’une nutrition entérale et 34 d’une nutrition parentérale. Le ratio nutrition entérale vs nutrition parentérale était de 5. Le nombre de consultations réalisées était de 3135. Trois cents vingt-huit alertes par les délégués (diététiciens) aux délégants (médecins) étaient identifiées dans le cadre du protocole soit 10,5 % des consultations réalisées. Les alertes contre indiquent la mise en place ou le suivi de la nutrition par le délégué. Une alerte est déclenchée en cas de diminution du performance status, de douleurs abdominales, ou de perte de voies d’abord par exemple… Pour les critères IPAQSS, 1338 patients étaient dépistés par les délégués en conformité avec le niveau 3 (poids, perte de poids et IMC) soit 96,81 % des patients. Aucun événement indésirable n’était identifié par la cellule qualité dans le cadre du protocole de coopération.
Le PCMD est faisable avec une grande efficience en terme de dépistage des troubles nutritionnels et de prise en charge en nutrition artificielle en accord avec les recommandations. Les alertes sont fonctionnelles, objectivent un renforcement de la sécurité des patients et participe à la formation des professionnels. Pour les délégués, ce protocole renforce les compétences et permet une évolution du métier avec une reconnaissance professionnelle et une sécurisation des pratiques. Cette organisation pilote au niveau national a permis la formation de 4 diététiciennes nutritionnistes du centre Léon Berard à Lyon. D’autres centres comme La Pitié-Salpêtrière s’engagent dans ce projet. Un DU spécifique est mis en place en 2019 intitulé « Nutrition et Cancer », formation intégrant le protocole de coopération.
Dans le cadre de la nutrition artificielle et en accord avec les recommandations de l’assurance maladie 1, notre équipe a souhaité développer une consultation de télémédecine en partenariat avec les ...patients, les aidants, et les prestataires de santé. Nous présentons un bilan à 7 mois.
La téléconsultation était proposée aux patients sous nutrition artificielle vus en consultation classique. Un seul médecin de l’équipe testait le processus. En l’absence de matériel de communication dédié, les téléphones portables (médecin et prestataires) étaient utilisés avec WhatsApp. Les téléconsultations étaient mises en place 2jours par semaine, toutes les 30minutes et adaptées à la « tournée » des prestataires. Les personnes présentes à la téléconsultation étaient obligatoirement le patient, le prestataire, le médecin prescripteur et selon les circonstances, l’aidant et l’infirmière libérale. Aucun document n’était échangé pendant la téléconsultation. Un courrier était ensuite dicté et la cotation effectuée.
Du 23/01/2019 au 02/09/2019, 32 patients participaient, d’âge moyen de 65,5 ans (extrême, 51–83). Il n’était observé aucun refus de participation. L’origine géographique des patients était l’Hérault (n=15), le Gard (n=11), les Pyrénées Orientales (n=2), la Lozère (n=2), le Tarn (n=2). 31 patients étaient sous nutrition entérale et un sous nutrition parentérale. Les pathologies concernées étaient des tumeurs d’origine tête et cou (n=19), œsophage (n=6), pancréas (n=3), lymphome (n=1), rectum (n=1), poumon (n=1). Une atteinte aspergillaire concernait un patient. Parmi les 32 patients, 14 bénéficiaient d’une seconde téléconsultation, et 5 d’une troisième. Onze patients stoppaient leur nutrition entérale au cours de cette étude: deux patients décédés (évolution de la maladie néoplasique), un patient avec relais par de la nutrition parentérale pour carcinose péritonéale, et 8 patients chez qui la nutrition artificielle n’était plus indiquée. Parmi ces 8 patients, 6 patients étaient porteurs d’une gastrostomie et la retiraient eux-mêmes à domicile. La téléconsultation était valorisée par les codes spécifiques TC+MCS (Majoration Coordination des Soins)=23€+5€. Les principaux inconvénients étaient l’absence d’examen physique, des problèmes ponctuels de connexion et la ponctualité parfois difficile à respecter. Les principaux avantages étaient l’absence de déplacement du patient et l’évaluation nutritionnelle complète apportée par le prestataire.
La téléconsultation est parfaitement adaptée au suivi de la nutrition artificielle à domicile. La place du prestataire est totalement novatrice dans ce processus. Pour le médecin prescripteur, la présence d’un professionnel de la nutrition optimise et sécurise la consultation. Cependant, en l’absence d’examen physique, la place du médecin traitant est probablement à redéfinir.
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