We investigate the application of time reversed electromagnetic wave propagation to transmit energy to a moving target in a reverberant environment. “Time reversal” is a signal focusing method that exploits the time reversal invariance of the lossless wave equation to focus signals on a small region inside a complex scattering environment. In this work, we explore the properties of time reversed microwave pulses in a low-loss ray-chaotic chamber. We measure the spatial profile of the collapsing wavefront around the target antenna, and demonstrate that time reversal can be used to transfer energy to a receiver in motion. We discuss the results of these experiments, and explore their implications for a wireless power transmission system based on time reversal.

QOL-21. DIET AND HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN THE PRIMARY BRAIN TUMOR POPULATION Dina M. Randazzo, Frances McSherry, James E. Herndon, II, Mary L. Affronti, Eric S. Lipp, Charlene Flahiff, Elizabeth Miller, Sarah Woodring, Maria Freeman, Patrick Healey, Janet Minchew, Susan Boulton, Annick Desjardins, Gordana Vlahovic, Henry S. Friedman, and Katherine B. Peters; Duke University Medical Center, Durham, NC, USA BACKGROUND: Many diets have been recommended for cancer patients, including ketogenic, vegetarian, alkaline, and calorie-restricted diets. Despite these recommendations, evidence is lacking. The goal of this study was to discern if patients with primary brain tumors used a diet and if it was associated with HRQoL. METHODS: Demographic and clinical data from the PRoGREss registry at the Preston Robert Tisch Brain Tumor Center at Duke, along with patient-outcome questionnaires, were queried retrospectively from December 16, 2013 to February 28, 2014. Kruskal-Wallis and Wilcoxon tests were performed to explore any associations between diet and HRQoL. RESULTS: 783 patients were identified with 81 (10%) using a special diet the last 12 months, 515 (66%) not using a special diet, and 297 (24%) with missing diet information. The majority of patients were male (n 1⁄4 423, 54%), married (n 1⁄4 463, 59%), college educated (N 1⁄4 438, 56%), had WHO grade III-IV tumors (N1⁄4 539, 69%), and the average age was 49.6 (13.6) years. Special diets reported by the 81 patients included: ketogenic (N 1⁄4 9, 11%), low carb (N 1⁄4 11, 14%), vegetarian/vegan (N 1⁄4 6, 7%), organic (N 1⁄4 8, 10%) and unspecified (27, 33%). Among those patients who used a special diet, 43% exercised ≥9 MET-hrs/wk; however, among patients who did not use a special diet, only 30% exercised ≥9 MET-hrs/wk. The HRQoL in patients using a special diet was better than the HRQoL in patients who did not use a special diet relative to the following outcomes: FACIT-Fatigue, FACT-G functional subscale, FACT-Br TOI, and the Brain cancer subscale. CONCLUSIONS: A small percentage of our primary brain tumor patients reported using a special diet. Given the general lack of evidence regarding diet and its potential effect on primary brain tumors, more research is needed in this area utilizing more accurate methods to identify and validate the diets used and to reduce missing data. Neuro-Oncology 17:v188–v194, 2015. doi:10.1093/neuonc/nov230.21 Published by Oxford University Press on behalf of the Society for Neuro-Oncology 2015.

Background: Dementia care providers need a clinical assessment tool similar to the blood pressure cuff (sphygmomanometer) used by clinicians and patients for managing hypertension. A "blood pressure cuff" for dementia would be an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument for providers and informal caregivers to measure severity of dementia symptoms. The purpose of this study was to assess the reliability and validity of the Healthy Aging Brain Care Monitor (HABC-Monitor) for measuring and monitoring the severity of dementia symptoms through caregiver reports.Methods: The first prototype of the HABC-Monitor was developed in collaboration with the Indianapolis Discovery Network for Dementia, which includes 200 members representing 20 disciplines from 20 local organizations, and an expert panel of 22 experts in dementia care and research. The HABC-Monitor has three patient symptom domains (cognitive, functional, behavioral/psychological) and a caregiver quality of life domain. Patients (n = 171) and their informal caregivers (n = 171) were consecutively approached and consented during, or by phone shortly following, a patient's routine visit to their memory care provider.Results: The HABC-Monitor demonstrated good internal consistency (0.73-0.92); construct validity indicated by correlations with the caregiver-reported Neuropsychiatric Inventory (NPI) total score and NPI caregiver distress score; sensitivity to three-month change compared with NPI "reliable change" groups; and known-groups validity, indicated by significant separation of Mini-Mental Status Examination severity groups and clinical diagnostic groups. Although not designed as a screening study, there was evidence for good operating characteristics, according to area under the receiver-operator curve with respect to gold standard clinical diagnoses, relative to Mini-Mental Status Examination or NPI.Conclusion: The HABC-Monitor demonstrates good reliability and validity as a clinically practical multidimensional tool for monitoring symptoms of dementia through the informal caregiver.

BACKGROUND:The US Institute of Medicine has recommended an integrated, locally sensitive collaboration among the various members of the community, health care systems, and research organizations to improve dementia care and dementia research.METHODS:Using complex adaptive system theory and reflective adaptive process, we developed a professional network called the "Indianapolis Discovery Network for Dementia" (IDND). The IDND facilitates effective and sustainable interactions among a local and diverse group of dementia researchers, clinical providers, and community advocates interested in improving care for dementia patients in Indianapolis, Indiana.RESULTS:The IDND was established in February 2006 and now includes more than 250 members from more than 30 local (central Indiana) organizations representing 20 disciplines. The network uses two types of communication to connect its members. The first is a 2-hour face-to-face bimonthly meeting open to all members. The second is a web-based resource center (http://www.indydiscoverynetwork.org ). To date, the network has: (1) accomplished the development of a network website with an annual average of 12,711 hits per day; (2) produced clinical tools such as the Healthy Aging Brain Care Monitor and the Anticholinergic Cognitive Burden Scale; (3) translated and implemented the collaborative dementia care model into two local health care systems; (4) created web-based tracking software, the Enhanced Medical Record for Aging Brain Care (eMR-ABC), to support care coordination for patients with dementia; (5) received more than USD$24 million in funding for members for dementia-related research studies; and (6) adopted a new group-based problem-solving process called the "IDND consultancy round."CONCLUSION:A local interdisciplinary "think-tank" network focused on dementia that promotes collaboration in research projects, educational initiatives, and quality improvement efforts that meet the local research, clinical, and community needs relevant to dementia care has been built.

Despite numerous quality improvement efforts, best practice guidelines, and clinical and basic research activities over the past three decades, dementia is still underdiagnosed and undertreated, especially among minorities. Furthermore, even among those receiving optimal care, only a small proportion participate in clinical trials. The Institute of Medicine has recommended the need for system thinking and integrated, locally sensitive collaboration among the various members of the local community, health care systems and research organizations. It is hypothesized that an effective collaboration would improve diagnosis and treatment of the dementia patient, as well as increase participation in research. A local and diverse network of dementia researchers, clinical providers, patient advocates and policy makers who are interested in improving the care for dementia patients in Indianapolis were invited to participate in bimonthly face-to-face meetings and regular email interactions. The Network uses the Complex Adaptive System theoretical framework and the Reflective Adaptive Process to facilitate and sustain effective interactions among its members. The Network was established in February 2006 and includes more than 150 members from more than 20 local organizations, representing over 20 disciplines. To date, the network has built a web-based resource center, created a social networking forum through Facebook, has delivered numerous educational seminars, developed and disseminated educational materials and quick reference cards; and developed numerous clinical tools. Currently, the Network is deploying research projects into community practices, looking at a new screening and management tool (the Healthy Aging Brain Care Monitor), has developed an electronic medical record specifically designed to address the concerns of the cognitively impaired population (eMR-ABC), and has taken a NIH funded study into primary care practices outside of academic practice setting (PRISM-PC). Building and sustaining a local interdisciplinary “think-tank” network in dementia facilitates conducting various collaborative research, educational and quality improvement programs that meet the local research, clinical, and community needs relevant to dementia.

Demand for less invasive surgical intervention has increased in recent years resulting in surgeons occasionally being pressurised into adopting new techniques before evidence of safety and efficacy has been established. Unlike pharmaceutical research, most innovative surgical procedures enter surgical practice without regulatory oversight. This anomaly was recently highlighted in the 'Bristol Report' resulting in a recommendation that unproven therapies or surgical techniques be subjected to ethical overview or independent oversight. When a novel technique is introduced, the surgeon will find himself/herself gaining proficiency and experience on suitable patients. Hence the surgeon embarks on a 'learning curve'. A learning curve can be defined as a graphic representation showing the relationship between experience with a procedure and outcome. Studies demonstrate that learning curves generally 'flatten out' as experience increases, resulting in fewer complications and less of a need to convert to the standard procedure. In addition to lack of regulatory oversight, it is this learning curve that gives rise to many ethical and legal dilemmas. This paper considers the ethical issues relating to a surgeon's candour and clinical equipoise, the legal standard of care in a negligence action and the ethical and legal implications regarding risk disclosure during informed consent. The paper concludes by considering a more patient centred approach where new and innovative therapies are being considered in order to ensure good medical practice and avoid litigation for allegations of negligence or breach of human rights.

This paper questions the dogmatic stance of the domestic courts toward mandatory orders for treatment, arguing that this has the potential to subjugate patients' interests to clinical discretion, and proposing a via media to accommodate the legitimate concerns of all parties.

We assessed the prevalence of symptomatic, refluxing systems as a cause of recurrent urinary tract infection (UTI) in patients who underwent renal transplantation as result of renal failure from reflux nephropathy. Eleven patients from the age of 8 to 19 yr underwent renal transplantation for renal failure because of reflux nephropathy, between 1992 and 2003. Culture documented UTI were investigated and correlated with pre- and postoperative infection rates, voiding dysfunction (VD), concomitant nephrectomy, or nephroureterectomy with refluxing native remnants, and pretransplant ureteral reimplantation. Four patients with nephroureterectomies and no VD were infection free post-transplant. Two of three patients reimplanted pretransplant with a history of VD had one or more UTI per month. Patients with nephrectomies without partial ureterectomies with or without VD also had one or more UTI per month. Refluxing systems in the immunosuppressed transplant patient may play a role in UTI especially when associated with VD. Surgical intervention of native refluxing systems may be warranted.