睿学教育Wisdome Education

William J. Klish, MD

• Professor of Pediatrics
• Baylor College of Medicine
• Texas Children? Hospital
• Houston, Texas

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Protein-bound D-amino acids antibiotic gastroenteritis cheap ketoconazole cream 15 gm overnight delivery, and to a lesser extent lysinoalanine antibiotic drops for conjunctivitis buy discount ketoconazole cream 15 gm on line, decrease true ileal protein digestibility in minipigs as determined with 15N-labeling infection of the brain ketoconazole cream 15 gm purchase with mastercard. Milk and nutrient intake of breast-fed infants from 1 to 6 months: Relation to growth and fatness. Total sulfur amino acid requirement in young men determined by indicator amino acid oxidation with L-[1-13C] phenylalanine. Twin preg- nancy: The impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes. Ability of the Higgins Nutrition Intervention Program to improve adolescent preg- nancy outcome. The effect of varying protein quality and energy intake on the nitrogen metabolism of parenterally fed very low birthweight (<1600 g) infants. The dietary administration of monosodium glutamate or glutamic acid to C-57 black mice for 2 years. Amino acid excesses for young pigs: Effects of excess methionine, tryptophan, threonine or leucine. Effect of excess levels of methionine, tryptophan, arginine, lysine or threonine on growth and dietary choice in the pig. Protein needs of Chilean pre-school children fed milk and soy protein isolate diets. Protein-Energy Requirement Studies in Developing Countries: Results of Inter- national Research. The amino acid methionine reduces the valproic acid-induced spina bifida rate in the mouse. Effects of ingested steak and infused leucine on forelimb metabolism in man and the fate of the carbon skeletons and amino groups of branched-chain amino acids. The 24-h pattern and rate of leucine oxidation, with par- ticular reference to tracer estimates of leucine requirements in healthy adults. Validation of the tracer-balance concept with reference to leucine: 24-h intravenous tracer studies with L-[1-13C]leucine and [15N-15N]urea. Moderate exercise at energy bal- ance does not affect 24-h leucine oxidation or nitrogen retention in healthy men. Twenty-four-hour oral tracer studies with L-[1-13C]lysine at a low (15 mg⋅kg–1⋅d–1) and intermediate (29 mg⋅kg–1⋅d–1) lysine intake in healthy adults. Changes in total body composition during normal and diabetic pregnancy: Relation to oxygen consumption. Leucine uptake by splanchnic and leg tissues in man: Relative independence of insulin levels. Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro. Correlations between brain tryptophan and plasma neutral amino acid levels following food consumption in rats. Short-term neuroendocrine effects of a large oral dose of monosodium glutamate in fasting male subjects. Rat embryo development on human sera is related to numbers of previous spontaneous abortions and nutritional factors. Correlation of aspartate dose, plasma dicarboxylic amino acid concentration, and neuronal necrosis in infant mice. Aspartate-induced neuronal necrosis in infant mice: Protective effect of carbohydrate and insulin. The 24-h whole body leucine and urea kinetics at normal and high protein intakes with exercise in healthy adults. Resting metabolic rate and body composi- tion of healthy Swedish women during pregnancy. Effect of chronic dietary treatment with L-tryptophan on spontaneous salt appetite of rats. Role of insulin and branched-chain amino acids in regulating protein metabolism during fast- ing. Impact of supplemental lysine or tryptophan on pregnancy course and outcome in rats.

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There will be an introductory tutorial in Fresher’s Week so that everyone has the opportunity to familiarize themselves with the tutorial platform antibiotics for dogs at feed store discount generic ketoconazole cream canada. We would be grateful if all students could always be present in the tutorial room five minutes before the tutorial is due to start antibiotics kellymom buy discount ketoconazole cream 15 gm line. Online resources and OpenMed In addition to the core teaching material antibiotics making sinus infection worse best ketoconazole cream 15 gm, we will be encouraging use of open- access resources that have been released (usually by other teaching or educational organisations) under creative commons licenses for general teaching use. We have collated these into different clinical specialties and graded them for level of user and quality; they can be accessed through the OpenMed website at openmed. For each specialty area we have grouped resources into a useful learning pathway or curriculum. Many of our tutors will be adding and rating resources in their specialty areas and will point you in the direction of any useful additional resources. Anyone interested in contributing to the website should contact Dr Eleri Williams. Library facilities and e-textbooks Library facilities will be provided electronically through the University of Edinburgh Library Online. Students will also have access to the physical library buildings if they do wish to access these in Edinburgh. The University library will allow access to most journals and online e-textbooks related to the course. Computer requirements Computer and broadband A computer and internet access (preferably broadband) are required to participate in the course. A webcam is very useful for full participation in tutorials but a microphone and headphones will allow ‘voice-only’ participation. Software / computer configurations We will ask you to download some free software and to run configurations to ensure your computer is set up to run some of the e-learning resources (e. You will be given full details of this prior to commencing the course—see below for further details: Flash player Check you have the latest Flash Player (Version 9 or above) How do I know what version of Flash Player I have? Two ways of doing this, either: a) Right-click any flash object in a web browser b) Click on Start> Control Panel >Add/Remove Programs. A dialogue appears that tells you the version of Flash Player currently installed. Wimba Classroom Ensure that your computer is configured to run Wimba (the online tutorial software) before starting the course. Please use the ‘wizard’ to check that your computer and headset are set up for Wimba: edlive. The following are links to demos/videos showing how Wimba Classroom works: Wimba basics: www. Email When you join the University you will get a University of Edinburgh email account and address which will be used for a variety of essential communications. You must access and manage this account regularly as important information from the University will be sent to this address. If you already have a web-based email account and think you are unlikely to check your University email account, it is your responsibility to set up a forward on your University email. Change of details It is vital that you inform Registry Services of any change to details. You are given the opportunity to check and amend your details annually via your Registration Forms, but details can be changed at any time using the online form found here: www. Transkills training Transkills run a range of personal and professional development training courses for students across the University. Course organisers Eleri Williams (Lecturer in Internal Medicine) has responsibility for the day-to- day running of the course, and should be the first point of contact for all students. Associate tutors Associate tutors with specialist expertise will be invited to contribute/run modules in their specialty areas. The programme director is also there to facilitate your orientation and smooth progression through the degree, from initial induction to subsequent course choice, and the transition into the dissertation stage and to the successful completion of the degree. It is your responsibility to inform the programme director immediately of any problems that are interfering with your coursework or progress through the programme, including any religious or medical requirements that might affect your participation in any aspect of the programme.

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Making sure that all staff are well informed of any new developments (they may be approached byMaking sure that all staff are well informed of any new developments (they may be approached byMaking sure that all staff are well informed of any new developments (they may be approached by journalists too) using: i antibiotics resistance news ketoconazole cream 15 gm buy without a prescription. Intra/internet updatesIntra/internet updates Easy access to information for journalists and the general public antibiotic drops for swimmer's ear discount 15 gm ketoconazole cream. Agree on the message but be ready to adapt iton the message but be ready to adapt it constantly as new facts emerge infection 10 weeks postpartum discount ketoconazole cream online visa. Use sympathetic journalists/media to get across your views to specific/targeted audiences. Use sympathetic journalists/media to get across your views to specific/targeted audiences. Use sympathetic journalists/media to get across your views to specific/targeted audiences. Much of the background information and accompanying text can be prepared inplanning. Much of the background information and accompanying text can be prepared inplanning. Much of the background information and accompanying text can be prepared in advance of a case of H5N1. Different scenarios can be envisaged and the appropriate information for eachadvance of a case of H5N1. Different scenarios can be envisaged and the appropriate information for eachadvance of a case of H5N1. Different scenarios can be envisaged and the appropriate information for each prepared. It is very easy to stray into and comment on other topics to reinforce your point. Taking the scientific approach of waiting for evidence before commenting on likely routes of infection may be seen as ‘sitting on the fence’, especially when media will want immediate answers. This includes personnel managing a site, assessing the risk of an outbreak, reducing the risk of disease emergence, involved in the diagnosis and surveillance of a disease, and controlling an outbreak. Training is particularly important for front-line personnel, who are likely to come into contact with an incursion or outbreak of disease first, such as, wetland managers and members of disease diagnostic teams. All appropriate stakeholders should be thoroughly trained in their roles and responsibilities in a disease emergency. More intense and specialised training is needed for personnel/professionals holding key positions, such as members of specialist diagnostic and surveillance teams, forecasting experts and animal and human health professionals. Moreover, training programmes should be comprehensive and regular, to accommodate the possibility that a disease may occur in any part of a country, and to allow for staff turnover. Training must extend to staff in remote areas, as well as to selected officials, such as local authorities. Back up staff for each position should also be trained, in the eventuality of absent front-line staff. It will not always be possible, or practical, to train all personnel to a high level of expertise in the diseases themselves. Knowledge of basic clinical, pathological and epidemiological features of diseases known to be important, or potentially important, to a site, together with an understanding of actions to be taken when the presence of disease is suspected, may suffice in many circumstances. Importantly, the principles and practicalities of investigating a disease outbreak with an open mind should be the subject of training [►Section 3. The following training possibilities may be selected, as appropriate: National emergency disease training workshops: coordinated workshops should form the focus of training and should target those involved in each stage of managing an outbreak. These workshops should be organised by trained personnel and ideally include representatives from, for example, neighbouring counties or regions, or those countries or regions with experience of dealing with the specific disease in question. Exchange of personnel: key staff should be sent to other disease control centres which are proficient in dealing with the relevant disease, particularly those in the process of controlling an outbreak, to gain first-hand experience of steps taken to manage an outbreak. Other opportunities for staff to gain knowledge and understanding of managing outbreaks, such as attending workshops, should also be utilised.

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The two drawings – one vertical and one hor- Incoming x-ray photons izontal – are attempts to illustrate the basic principles for an x-ray photo virus definition update order 15 gm ketoconazole cream with visa. Absorber Part of the body Transmitted Electron photons The x-rays is absorbed according to the electron density Incoming photons Detector Scattered flm antibiotic resistance kanamycin cheapest generic ketoconazole cream uk, fuoeresent screen virus 90 order genuine ketoconazole cream on-line, etc. The x-ray source On page 8 we described the basic principles for the formation of x-rays – or rather bremstrahlung. When electrons with high energy smash into the “anticathode” – a tiny part of the energy is trans- formed into radiation. This implies that the x-ray photons formed, may have a number of different energies – in fact a whole spectrum is formed (the “Initial spectrum” in the fgure below). X-rays are usually described by their maximum energy, which is determined by the voltage between the electrodes. The amount or frac- tion of the electron energy that is transformed into x-rays from the anode surface is only about a percent of the electron energy. This implies that most of the energy is dissipated as heat, and consequently the anode must be cooled. The probability for transferring the elec- tron energy into radiation is proportional to Z E. The result is a spec- trum – in the fgure called “initial spectrum” In order to use the radiation it must get out of the X-ray tube. The spectrum changes like that illustrated above – from the “initial spectrum” into the “fnal spectrum”. For example, if low energy x-rays are needed, a beryllium window is used since this window has much lower density than a glass window. The spectrum also contains characteristic x-rays from dislodging of K- and L-shell electrons from the target. This will not be further discussed when the x-rays are used for diagnostic purposes, but is important for x-ray crystallography. We are not going to describe all the technological developments with regard to the control of the exposure time – and equipment for the different types of examinations. Thus, in the case of mammography the maximum energy is low (below 30 kV) whereas in skeletal and abdominal examinations the energy is larger, between 60 to 85 kV. Another aspect is that the radiation dose in an examination should be kept as low as possible. Several developments – using intensifying screens have reduced the exposure (see below). Absorption and scattering in the body The x-ray picture is based on the radiation that penetrates the body and hit the detector (flm). The details in the picture are due to those photons that are absorbed or scattered in the body. Since both the absorption and the scattering depend upon the electrons in the object (body) we can say that; “the x-ray picture is a shadow-picture of the electron density in the body. Since x-ray diagnostic uses low energy radiation only the ”photoelectric effect” and the “Compton scattering” contribute to the absorption. The photoelectric effect occur with bound electrons, whereas the Compton process occur with free or loosly bound electrons. Both processes vary with the radiation energy and the atomic number of the absorber. Photoelectric effect – variation with photon energy For the energy region in question – and for atoms like those found in tissue the photoelectric cross- section varies with E–3. Photoelectric effect – variation with atomic number The variation with the atomic number is quite complicated. For an energy above the absorption edge, the cross-section per atom varies as Z4 (i. It can be noted that the K-shell energy for all atoms in the body (C, N, O, P, and Ca) is below 4 keV. Compton effect – variation with photon energy For the energy range used for diagnostic purposes the Compton effect is rather constant – and de- creases slightly with the energy. Compton effect – variation with atomic number The Compton process increases with the electron density of the absorber.

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Students who sign up for this package will obtain one (1) extra unit upon graduation virus 7g7 ketoconazole cream 15 gm order online. Students taking the minor package have to begin with level 100 and then proceed to the subsequent levels bacteria 4 living conditions buy ketoconazole cream on line amex. The wisdom to comfort and counsell all our patients towards well being antimicrobial floor mats purchase ketoconazole cream 15 gm with mastercard, peace and harmony regardless of their social status, race and religion. The ability to understand that our profession is sacred, dealing with your most precious gifts of life and intellect. We promise to devote our lives in serving Mankind, poor or rich, literate or illiterate, irrespective of race and religion with patience and tolerance, with virtue and reverence, with knowledge and vigilance, and with Your love in our hearts. If there is any other information that you think should be included in the guidebook, please suggest in the space below. The Statistician 32 (1983) 307-317 © 1983 Institute of Statisticians Measurement in Medicine: the Analysis of Method Comparison Studies† D. The use of correlation, regression and the difference between means is criticized. A simple parametric approach is proposed based on analysis of variance and simple graphical methods. Frequently, however, we cannot regard either method as giving the true value of the quantity being measured. In this case we want to know whether the methods give answers which are, in some sense, comparable. For example, we may wish to see whether a new, cheap and quick method produces answers that agree with those from an established method sufficiently well for clinical purposes. Yet few really answer the question “Do the two methods of measurement agree sufficiently closely? We will restrict our consideration to the comparison of two methods of measuring a continuous variable, although similar problems can arise with categorical variables. Comparison of means Cater (1979) compared two methods of estimating the gestational age of human babies. He divided the babies into three groups: normal birthweight babies, low birthweight pre-term (< 36 weeks gestation) babies, and low birthweight term babies. For each group he compared the mean by each method (using an unspecified test of significance), finding the mean gestational age to be significantly different for pre-term babies but not for the other groups. His criterion of agreement was that the two methods gave the same mean measurement; “the same” appears to stand for “not significantly different”. By his criterion, the greater the measurement error, and hence the less chance of a significant difference, the better. Correlation The favourite approach is to calculate the product-moment correlation coefficient, r, between the two methods of measurement. The correlation coefficient in this case depends on both the variation between individuals (i. In some applications the “true value” will be the subject’s average value over time, and short-term within-subject variation will be part of the measurement error. In others, where we wish to identify changes within subjects, the true value is not assumed constant. The correlation coefficient will therefore partly depend on the choice of subjects. For if the variation between individuals is high compared to the measurement error the correlation will be high, whereas if the variation between individuals is low the correlation will be low. This can be seen if we regard each measurement as the sum of the true value of the measured quantity and the error due to measurement. We have: 2 variance of true values = σT 2 variance of measurement error, method A = σA 2 variance of measurement error, method B = σB In the simplest model errors have expectation zero and are independent of one another and of the true value, so that 2 2 variance of method A = σA + σT 2 2 variance of method B = σB + σT 2 covariance = σT (see appendix) Hence the expected value of the sample correlation coefficient r is 2 σ T ρ = 2 2 2 2 (σ A + σT )(σ B + σT ) 2 2 2 2 2 Clearly ρ is less than one, and it depends only on the relative sizes of σT , σA and σB. If σA and σB 2 are not small compared to σT , the correlation will be small no matter how good the agreement between the two methods. In the extreme case, when we have several pairs of measurements on the same individual, 2 σT = 0 (assuming that there are no temporal changes), and so ρ = 0 no matter how close the agreement is. They concluded that the two methods did not agree because low correlations were found when the range of cardiac output was small, even though other studies covering a wide range of cardiac output had shown high correlations. In fact the result of their analysis may be 308 explained on the statistical grounds discussed above, the expected value of the correlation coefficient being zero.

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This patient has pericarditis bacteria history buy ketoconazole cream 15 gm lowest price, an extremely un- noma in 50% of test cases bacteria 3 shapes purchase 15 gm ketoconazole cream free shipping, but were wrong in 30% of common reason for chest pain antibiotic 127 order ketoconazole cream once a day, but a condition with a char- 109 these decisions. These studies were done Unfortunately, the unconscious use of heuristics can also with simulated clinical cases in a formal research setting predispose to diagnostic errors. If a problem is solved using and, although suggestive, it is not clear that the results the availability heuristic, for example, it is unlikely that the would be the same with cases seen in actual practice. Similarly, using the representativeness heuristic autopsy findings as the gold standard. Physicians were asked to provide the clinician may not adequately take into account that other clinical diagnosis and also their level of uncertainty: level 1 diseases may be much more common and may sometimes represented complete certainty, level 2 indicated minor un- present similarly. Of rates at which the autopsy showed significant discrepancies these, premature closure and the context errors are the most 86 between the clinical and postmortem diagnosis were essen- common causes of cognitive error in internal medicine. Specifically, clini- cians who were “completely certain” of the diagnosis ante- Premature Closure. Similar findings choice of diagnostic hypotheses too early in the process, 112 were reported by Landefeld and coworkers : the level of such that the correct diagnosis is never seriously consid- 117–119 physician confidence showed no correlation with their abil- ered. This is the medical equivalent of Herbert Si- 120 ity to predict the accuracy of their clinical diagnosis. Yet, the the tendency to seek out data that confirm one’s original 115 confidence level of the worst performers was actually higher idea rather than to seek out disconfirming data. Very early in clinical problem solving, healthcare practitioners start to characterize a problem in Causes of Cognitive Error. Retrospective studies of the terms of the organ system involved, or the type of abnor- accuracy of diagnoses in actual practice, as well as the 77,106,114,115 mality that might be responsible. For example, in the in- autopsy and other studies described previously, stance of a patient with new shortness of breath and a past have attempted to determine reasons for misdiagnosis. Most history of cardiac problems, many clinicians quickly jump of the cognitive errors in diagnosis occur during the “syn- to a diagnosis of congestive heart failure, without consid- thesis” step, as the physician integrates his/her medical 106 eration of other causes of the shortness of breath. This a patient with abdominal pain is likely to be diagnosed as process is largely subconscious and automatic. Research on these automatic responses has re- situations, clinicians are biased by the history, a previously vealed a wide variety of heuristics (subconscious rules of established diagnosis, or other factors, and the case is for- 116 thumb) that clinicians use to solve diagnostic puzzles. Relevant research has been conducted tools that allow problems to be solved quickly and, typi- on how physicians make diagnoses in the first place. Early Berner and Graber Overconfidence as a Cause of Diagnostic Error in Medicine S9 121 work by Elstein and associates, and Barrows and col- initial impression is wrong and to having back-up strategies 122–124 leagues showed that when faced with what is per- readily available when the initial strategy does not work. They then gather more data to tions as to whether experts follow a hypothetico-deductive evaluate these hypotheses and finally reach a diagnostic con- or a pattern-recognition approach. This approach has been referred to as a hypothetico- theory suggests that clinical judgment can appropriately deductive mode of diagnostic reasoning and is similar to the range from more intuitive to more analytic, depending on 121 the task. Intuitive judgment, as Hamm conceives it, is not traditional descriptions of the scientific method. It is during this evaluation process that the problems of confirmation some vague sense of intuition, but is really the rapid pattern bias and premature closure are likely to occur. Although hypothetico-deductive models may be fol- acteristic of experts in many situations. Although intuitive lowed for situations perceived as diagnostic challenges, judgment may be most appropriate in the uncertain, fast- there is also evidence that as physicians gain experience and paced field environment where Klein observed his subjects, expertise, most problems are solved by some sort of pattern- other strategies might best suit the laboratory environment recognition process, either by recalling prior similar cases, that others use to study decision making. In addition, forc- attending to prototypical features, or other similar strate- ing research subjects to verbally explain their strategies, as 125–129 130 128 done in most experimental studies of physician problem gies. As Eva and Norman and Klein have em- phasized, most of the time this pattern recognition serves the solving, may lead to the hypothetico-deductive description. However, it is during the times when it does found his subjects had a very difficult time articulating their not work, whether because of lack of knowledge or because strategies. A striking example derives from surveys of real world, either in content or in difficulty. As an example, academic professionals, 94% of whom rate themselves in 134 to study diagnostic problem solving, most researchers of the top half of their profession. Similarly, only 1% of 139 135 necessity use “diagnostically challenging cases,” which drivers rate their skills below that of the average driver.

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In addition virus unable to connect to the proxy server discount 15 gm ketoconazole cream visa, although there were increases in some measurements of strength antibiotic resistance grants discount ketoconazole cream 15 gm online, there was no effect attributable to diet antibiotic resistance and livestock cheap ketoconazole cream 15 gm on line. Therefore, the available data do not support the conclusion that the protein requirement for resistance training individuals is greater than that of nonexercising subjects. In view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise. Plant proteins are generally less digestible than animal proteins; however, digestibility can be altered through processing and preparation. Therefore, consuming a varied diet ensures an adequate intake of protein for vegetarians. Adult vegetarians consume less protein in their diet than non- vegetarians (Alexander et al. However, only one of these studies indicated that total protein intakes of 10 of the 25 vegan women were potentially inadequate (Haddad et al. As was shown in Table 10-13, the nitrogen requirement for adults based on high- quality plant food proteins as determined by regression analysis was not significantly different than the requirement based on animal protein or protein from a mixed diet. In conclusion, available evidence does not support recommending a separate protein requirement for vegetarians who consume complementary mixtures of plant proteins. However, nitrogen balance could not be applied to histidine since individuals take 56 days or more to go into negative nitrogen balance on a low histidine or histidine-free diet (Cho et al. The amino acid requirements thus developed are used as the basis for recommended protein scoring patterns discussed in a subsequent section. Further, there are no reports of healthy full-term infants exclusively and freely fed human milk who manifest any sign of amino acid or protein deficiency (Heinig et al. Four recent studies on the indispensable amino acid composition of human milk and their mean are shown in Table 10-18. The indispensable amino acid intake on a mg/L basis was calculated from the mean of the amino acid composition of mixed human milk proteins expressed as mg amino acid/g protein (Table 10-18) times the average protein content of human milk of 11. Children Ages 7 Months Through 18 Years Evidence Considered in Estimated the Average Requirement Nitrogen Balance. The only data derived directly from experiments to determine the indispensable amino acids requirements of children have been obtained by studying nitrogen balance. Pineda and coworkers (1981) conducted nitrogen balance studies in 42 Guatemalan children ranging in age from 21 to 27 months. Their mean amino acid estimates were reported to be: lysine, 66 mg/kg/d; threonine, 37 to 53 mg/kg/d; tryptophan, 13 mg/kg/d; methionine + cysteine, 28 mg/kg/d; isoleucine, 32 mg/kg/d; and valine, 39 mg/kg/d. Unfortunately, with the exception of lysine, no estimates of variance were published. For older children, the only data are those published by Nakagawa and coworkers in the 1960s (1961a, 1961b, 1962, 1963, 1964) on Japanese boys 10 to 12 years of age. Although these data seem to be accurate as there was uniformly negative nitrogen balance when the test amino acid was at zero, the maximum rate of nitrogen retention found when the amino acids were given in adequate quantities was 33 ± 14 mg/kg/d. Thus, it is likely that the values generated in this series of studies are overestimates of the actual requirement. Similar problems of interpreting nitrogen balance studies are apparent in the data for infants aged 0 to 6 months from a number of detailed studies in which infants were given multiple levels of amino acids (Pratt et al. With these studies also, the measured nitrogen balance was higher than what would be expected from the growth rates observed or estimated. Nonlinear regression analysis was used to fit the data for nitrogen balance versus amino acid intake to various curves, such as exponential, sigmoid, and bilinear crossover, in order to detect an approach to an asymptote or a breakpoint that could be equated with a requirement. How- ever, these attempts did not lead to interpretable results, which proved to be too sensitive to the specific criteria employed to define the point on the curve that would identify a requirement. In view of the reservations expressed above, the data from nitrogen balance studies in children were not utilized. Instead, the factorial approach was employed for children from 7 months through 18 years of age. In view of the doubts about the accuracy of the values generated by the empirical data, the factorial approach using data for growth (and its amino acid composition) and maintenance was utilized to determine requirements.

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References

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• Lorentini S, Amichetti M, Spiazzi L, et al. Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment. Strahlenther Onkol 2012;188(3):216-225.
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• Decousus H, Prandoni P, Mismetti P, et al. Fondaparinux for the treatment of superficialvein thrombosis in the legs. N Engl J Med 2010;363(13):1222-1232.