Multiple Projection Optical Diffusion Tomography with Plane Wave Illumination

We describe a new data collection scheme for optical diffusion tomography in which plane wave illumination is combined with multiple projections in the slab imaging geometry. Multiple projection measurements are performed by rotating the slab around the sample. The advantage of the proposed method is that the measured data can be much more easily fitted into the dynamic range of most commonly used detectors. At the same time, multiple projections improve image quality by mutually interchanging the depth and transverse directions, and the scanned (detection) and integrated (illumination) surfaces. Inversion methods are derived for image reconstructions with extremely large data sets. Numerical simulations are performed for fixed and rotated slabs

Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials.

BACKGROUND: Directly observed therapy has been recommended to improve adherence for patients with HIV infection who are on highly active antiretroviral therapy, but the benefit and cost-effectiveness of this approach has not been established conclusively. We did a systematic review and meta-analysis of randomised trials of directly observed versus self-administered antiretroviral treatment. METHODS: We did duplicate searches of databases (from inception to July 27, 2009), searchable websites of major HIV conferences (up to July, 2009), and lay publications and websites (March-July, 2009) to identify randomised trials assessing directly observed therapy to promote adherence to antiretroviral therapy in adults. Our primary outcome was virological suppression at study completion. We calculated relative risks (95% CIs), and pooled estimates using a random-effects method. FINDINGS: 12 studies met our inclusion criteria; four of these were done in groups that were judged to be at high risk of poor adherence (drug users and homeless people). Ten studies reported on the primary outcome (n=1862 participants); we calculated a pooled relative risk of 1.04 (95% CI 0.91-1.20, p=0.55), and noted moderate heterogeneity between the studies (I(2)= 53.8%, 95% CI 0-75.7, p=0.0247) for directly observed versus self-administered treatment. INTERPRETATION: Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question the use of such an approach to support adherence in the general patient population. FUNDING: None

Federal Employee Invention Rights - Time to Legislate

It is the purpose of this article to review judicial standards applicable to the determination of rights in inventions made by employees of the federal government, to note statutory provisions affecting the problem, to examine the content and effect of the present Executive program for determining such rights, to review and evaluate two fundamental and conflicting theories in this field, and to propose legislation establishing appropriate standards and procedures. This topic is believed to have general interest because, in addition to the urgencies suggested above, the problem touches some of the basic legal philosophy underlying the United States patent system

SPAD based imaging of Cherenkov light in radiation therapy

During radiotherapy, X-ray beams induce Cherenkov light emission in tissue as part of the dose delivery. This light can be used for dosimetry, in order to track and image the dose as it happens. The Cherenkov light levels are in the range of 10−6 to 10−9 W∕cm2, which makes it challenging to detect in a clinical environment. However, because the radiation is pulsed in 4 microsecond bursts, time-gated acquisition of the signal allows for robust detection, even in the presence of ambient room lighting. Thus, imaging sensors for this application must be highly sensitive and must be able to time gate faster than a microsecond. In this study, the use of a solid-state detector composed of 64x32 single photon avalanche diodes (SPAD) was examined. The advantages of this technology were intra-chip amplification, superior X-ray noise rejection, and fast temporal gating of the acquisition. The results show that the SPAD camera was sensitive enough to detect Cherenkov radiation despite the 3% fill factor. 2D oversampling (x25) was also used to increase final image resolution to 320x160. In this work we demonstrate the SPAD camera performance in imaging Cherenkov emission from a tissue optical phantom and one patient undergoing radiotherapy. The SPAD camera sensors could be a viable alternative for Cherenkov imaging, as compared to current imaging methods that are mostly focused around image intensifier-based cameras and so have a range of non-linearities and instabilities which could be solved by an all solid-state camera sensor. Please click Additional Files below to see the full abstract

Rethinking Supply Chains as Neighborhoods

This paper explores the implication of a neighborhood model for interfirm interactions that explicitly tries to create an equality matching relationship among firms in an industry. The aim is to examine what would happen if these firms worked to gain trust with each other with an eye toward maximizing the value of the collaboration across projects rather than just maximizing revenues in individual projects. A review of extant literature and an analysis of in-depth interviews yielded three actionable strategies that support the creation of a sustainable neighborhood in the construction industry: 1) Hub Strategy, 2) Trust Exercise Strategy, and 3) Sustainable Neighborhood Strategy. As envisioned in this study, the hub is a concentrated, inter-organizational structure for supply chain participants in large, complex projects. Importantly, hub members engage in a variety of technical activities that infuse ongoing and future projects with innovation, scope optimization, and operational efficiencies. Additionally, other activities within the hub are designed to purposefully allow participants to develop trust through collaboration before or outside of their primary contractual engagements. At present, this model has been examined for construction megaprojects, but the general neighborhood concept could be applied to many different industries and settings including manufacturing supply chains and collaborations among communities engaging in economic development. Future work will explore whether mechanisms like the hub and trust exercises can be applied in these other settings as well.IC2 Institut

EUS-guided verteporfin photodynamic therapy for pancreatic cancer

BACKGROUND AND AIMS: Locally advanced pancreatic cancer (LAPC) often causes obstruction. Verteporfin photodynamic therapy (PDT) can feasibly "debulk" tumor more safely than noncurative surgery and has multiple advantages over older PDT agents. We aimed to assess the feasibility of EUS-guided verteporfin PDT in ablating nonresectable LAPC. METHODS: Adults with LAPC with adequate biliary drainage were prospectively enrolled. Exclusion criteria included significant metastatic disease burden, disease involving >50% duodenal or major artery circumference, and recent treatment with curative intent. CT was obtained between day -28 to 0. On day 0, verteporfin 0.4 mg/kg was infused 60 to 90 minutes before EUS, during which a diffuser was positioned in the tumor and delivered light at 50 J/cm for 333 seconds. CT was obtained on day 2, with adverse event monitoring occurring on days 1, 2, and 14. Primary outcome was presence of necrosis. RESULTS: Of 8 patients (62.5% male, mean age 65±7.9 y) included in the study, 5 were staged at T3, 2 at T2, and 1 at T1. Most (4) had primary lesions in the pancreatic head. Mean pretrial tumor diameter was 33.3±13.4 mm. On day 2 CT, 5 lesions demonstrated a zone of necrosis measuring a mean diameter of 15.7±5.5 mm; 3 cases did not develop necrosis. No adverse events were noted during the procedure or postprocedure observation period (day 1-3), and no changes in patient reported outcomes were noted. CONCLUSIONS: In this pilot study, EUS-guided verteporfin PDT is feasible and shows promise as a minimally invasive ablative therapy for LAPC in select patients. Tumor necrosis is visible within 48 hours after treatment. Patient enrollment and data collection are ongoing

Phase I/II study of verteporfin photodynamic therapy in locally advanced pancreatic cancer

Background:Patients with pancreatic cancer have a poor prognosis apart from the few suitable for surgery. Photodynamic therapy (PDT) produces localised tissue necrosis but previous studies using the photosensitiser meso-tetrahydroxyphenylchlorin (mTHPC) caused prolonged skin photosensitivity. This study assessed a shorter acting photosensitiser, verteporfin.Methods: Fifteen inoperable patients with locally advanced cancers were sensitised with 0.4 mg kg-1 verteporfin. After 60-90 min, laser light (690 nm) was delivered via single (13 patients) or multiple (2 patients) fibres positioned percutaneously under computed tomography (CT) guidance, the light dose escalating (initially 5 J, doubling after each three patients) until 12 mm of necrosis was achieved consistently.Results:In all, 12 mm lesions were seen consistently at 40 J, but with considerable variation in necrosis volume (mean volume 3.5 cm 3 at 40 J). Minor, self-limiting extrapancreatic effects were seen in multifibre patients. No adverse interactions were seen in patients given chemotherapy or radiotherapy before or after PDT. After PDT, one patient underwent an R0 Whipple's pancreaticoduodenectomy.Conclusions:Verteporfin PDT-induced tumour necrosis in locally advanced pancreatic cancer is feasible and safe. It can be delivered with a much shorter drug light interval and with less photosensitivity than with older compounds. © 2014 Cancer Research UK

Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

<p>Abstract</p> <p>Background</p> <p>Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.</p> <p>Methods</p> <p>The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.</p> <p>Results</p> <p>The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength.</p> <p>Conclusion</p> <p>Malunion after distal radius fracture was associated with higher arm-related disability regardless of age.</p

Noninvasive Fluorescence Monitoring of Protoporphyrin IX Production and Clinical Outcomes in Actinic Keratoses Following Short-Contact Application of 5-Aminolevulinate

Topical 5-aminolevulinic acid (ALA) is widely used in photodynamic therapy (PDT) of actinic keratoses (AK), a type of premalignant skin lesion. However, the optimal time between ALA application and exposure to light has not been carefully investigated. Our objective is to study the kinetics of protoporphyrin IX (PpIX) accumulation in AK after short contact ALA and relate this to erythemal responses. Using a noninvasive dosimeter, PpIX fluorescence measurements (5 replicates) were taken at 20-min intervals for 2 h following ALA application, in 63 AK in 20 patients. Data were analyzed for maximal fluorescent signal obtained, kinetic slope, and changes in erythema. Our results show that PpIX accumulation was linear over time, becoming statistically higher than background in 48% of all lesions by 20 min, 92% of lesions by 1 h, and 100% of lesions by 2 h. PpIX accumulation was roughly correlated with changes in lesional erythema post-PDT. We conclude that significant amounts of PpIX are produced in all AK lesions by 2 h. The linear kinetics of accumulation suggest that shorter ALA application times may be efficacious in many patients. Noninvasive fluorescence monitoring of PpIX may be useful to delineate areas of high PpIX accumulation within precancerous areas of the skin